• 


8 


•:     : 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


^^^H 
• 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


-- 


H 


f).  *. 


ire. 


HANDBOOK  OF  HYGIENE 


AND 


SANITARY  SCIENCE. 


RICHTER'S    CHEMISTRY, 

A   TEXT-BOOK    OF    INORGANIC   CHEMISTRY    FOR    STUDENTS. 
By  PROF.  VICTOR  von  RICHTER, 

University  of  Brcslau. 

AUTHORIZED  TRANSLATION   FROM   THE   THIRD   GERMAN   EDITION. 
By  EDGAR  F.  SMITH,  M.  A.,  Ph.  D., 

Professor  of  Chemistry  in   Wittenberg  College,  Springfield,   Ohio ; 
formerly  in  the  Laboratories  of  the  University  of  Pennsyl- 
vania;  Member  of  the  Chemical  Society  of  Berlin. 

12mo.    89  Wood-cuts  and  Colored  Lithographic  Plate  of  Spectra.    $2.00 

In  the  chemical  text-books  of  the  present  day,  one  of  the  striking 
features  and  difficulties  we  have  to  contend  with  is  the  separate  presentation 
of  the  theories  and  facts  of  the  science.  These  are  usually  taught  apart, 
as  if  entirely  independent  of  each  other,  and  those  experienced  in  teaching 
the  subject  know  only  too  well  the  trouble  encountered  in  attempting  to  get 
the  student  properly  interested  in  the  science  and  in  bringing  him  to  a  clear 
comprehension  of  the  same.  In  this  work  of  PROF.  VON  RICHTER,  which 
has  been  received  abroad  with  such  hearty  welcome,  two  editions  having 
been  rapidly  disposed  of,  theory  and  fact  are  brought  close  together,  and 
their  intimate  relation  clearly  shown.  From  careful  observation  of  experi- 
ments and  their  results,  the  student  is  led  to  a  correct  understanding  of  the 
interesting  principles  of  chemistry.  The  descriptions  of  the  various  inor- 
ganic substances  are  full,  and  embody  the  results  of  the  latest  discoveries. 

In  preparation,  "  ORGANIC  CHEMISTRY."  By  the  same  author 
and  translator.  Nearly  ready. 

P.  BLAKISTON,  SON  &  CO.,  Medical  &  Scientific  Booksellers, 

1012  "Walnut  Street,  Philadelphia. 


HANDBOOK  OF  HYGIENE 


AND 


SANITARY  SCIENCE. 


BY 


CI;OR(;K  WILSON,  M.A.,  M.D.,  F.R.S.E., 


;    FELLOW  Ol  \1<Y    INSTITUTE   OF 

MI-:DII  AL   "iMc  i  i:    OF  H  l  in. 

Min-\VAK\vi<  KMIIK:    -AMI\K\    DI-TKICT. 


FIFTH     EDITION. 

KM. ARM. I)    AXI)    rAKKFTLIA'    KMVI.SED. 


\VIrriI     I  ILLUSTRATIONS. 


PHILADELPHIA: 

BLAKISTttN,  SOX  &  CO., 

1012  \YAi.\n    STKKI--.T. 
1884. 


'-5" 


PREFACE  TO  THE  FIFTH  EDITION. 

THE  very  favourable  reception  which  has  been  accorded 
to  this  Handbook  ever  since  it  was  first  published  renders 
any  lengthened  preface  unnecessary.  As  in  previous 
editions,  every  effort  has  been  made  to  keep  the  work  up 
to  date  ;  and  while  much  new  matter  has  been  interpo- 
lated throughout,  a  separate  chapter  has  been  written  on 
Vital  Statistics,  and  a  special  section  has  been  added  to 
the  chapter  on  Dwellings,  describing  more  fully  the  pro- 
minent sanitary  defects  in  houses,  and  how  they  may  be 
detected  and  remedied.  Several  new  engravings  have 
been  inserted,  to  illustrate  more  particularly  the  drainage 
of  houses  and  other  structural  details,  as  set  forth  in  the 
Model  By-laws  of  the  Local  Government  Board  ;  and  it 
will  be  seen  that  free  use  has  been  made  of  the  able  and 
exhaustive  reports  of  Dr.  Thome  on  Infectious  Hospitals, 
and  of  Dr.  Ballard  on  Trade  Nuisances. 

In  the  earlier  editions  a  considerable  amount  of  space 

devoted  to  the  consideration  of  subjects  which  apper- 

'tain  rather  to  the  domain  of  Domestic  Hygiene  ;  but  in 

JT~  '"  ••'i-*-i/f~% 

fv  >7b 


VI  PEEFACE  TO  THE  FIFTH  EDITION. 

the  last  and  present  editions  these  have  been  omitted, 
because  they  are  now  more  fully  treated  in  a  small 
supplementary  work  entitled  Healthy  Life  and  Healthy 
Dwellings. 

I  have  again  to  express  my  obligations  to  the  Sanitary 
Record,  and  other  periodicals  and  publications,  for  much 
valuable  information,  of  which  due  acknowledgment  is 
made  in  the  text;  while  my  best  thanks  are  due  to  Dr. 
Buchanan,  the  medical  officer  to  the  Local  Government 
Board,  for  kindly  favouring  me  with  copies  of  the  recent 
reports  made  by  the  medical  inspectors  of  that  Depart- 
ment, and  other  official  memoranda  which  are  given  in 
the  Appendix. 

23  CLAREMONT  ROAD,  LEAMINGTON, 

October  1883. 


CONTENTS. 
CHAPTER  I.— INTRODUCTORY. 

PUBLIC  HEALTH  AND  PREVENTABLE  DISEASE. 

PAGE 

Public  Hygiene,  definition  and  scope  of                     .  .1 

Sanitary  Science,  Historical  Sketch  of                       .  .2 

during  Middle  Ages  in  England   .  .          4 

,,       Seventeenth  Century         .  .         8 

„       Eighteenth  Century           .  .         8 

Suppression  of  Scurvy  and  Captain  Cook's  Labours  .         9 

Jail  Fever  and  John  Howard's  Labours        .  .10 

Discovery  of  Vaccination  by  Dr.  Jenner       .  .11 

Other  Sanitary  Triumphs  of  Eighteenth  Century  .        1 2 

Health  History  of  Present  Century                .  .12 

Increase  of  Population  and  Insanitary  Conditions  .        13 

Public  Health  Legislation  .               .              .  .14 

Amount  of  Preventable  Disease        .              .  .20 

Signs   of  improvement  judged  by  average  Annual 

Death-rate          .              .              .              .  .22 

Public  Health  Service         .              .              .  .25 

Relations  of  Curative  and  Preventive  Medicine  25 


Vlll  CONTENTS. 

CHAPTER  II. 

FOOD. 

PAGE 

SECTION  I. — FUNCTIONS  AND  CONSTITUENTS  OF  FOOD        .       27 

Conversion  of  Potential  Energy  of  Food  into  Dynamic 

Energy      .  .  .  .  .  .27 

Organic  and  Inorganic  Constituents     .  .  .27 

1.  Functions  of  the  Nitrogenous  Constituents  .        27 
Liebig's  Doctrines           .              .              .              .28 
Experiments  of  Drs.  Fick  and  Wislicenus  .        28 
Experiments  of  Dr.  Parkes           .              .              .28 
Dr.  Pavy's  Researches    .              .              .  .28 

2.  Functions  of  the  Fatty  Constituents         .  .29 

3.  Functions  of  the  Saccharine  Constituents  or  Hydro- 

carbons .  .  .  .  .30 

4.  Functions  of  Water  and  Saline  Matters   .  .30 
Proportions  of  the  Several  Constituents  in  a  Stand- 
ard Diet          .              .              .              .  .31 

SECTION  II.— NUTRITIVE  VALUES  OF  FOODS         .  .31 

Dr.  Letheby's  Table  of  Nutritive  Equivalents  .  .32 

SECTION  III. — FOOD  AND  WORK  .  .  .32 

Dr.  Edward  Smith's  Estimates  for  a  daily  Diet  during 
periods  of  Idleness  .  .  .  .33 

Dr.  Letheby's  Tables  for  Diets  during  Idleness,  ordinary 

Labour,  and  active  Labour  .  .  .  .33 

Daily  Requirements  of  the  Body,  as  shown  by  the 

Excretions  .  .  .  .  .34 

Dietaries  of  Low-fed  Operatives  .  .  .35 


CONTENTS.  IX 

PAGE 

Dietaries  of  Well-fed  Operatives     .....  .36 

Dietaries  of  Convicts .  .  ...  .36 

Relation  of  Convict-Labour  to  Diet      .  .       37 


SECTION  IV. — CONSTRUCTION  OF  DIETARIES  .       38 

1.  Influence  of  Sex    .  .  .38 

2.  Influence  of  Age   .  .  .  .38 

3.  Selection  of  Food .  .  .  .  .39 
Determined  by — 

(1.)  The  relative   Proportions   of   Proximate    Con- 
stituents    .              .              .  .  .39 
(2.)  Variety          .              .              .  .              .39 
(3.)  Digestibility                .              .  .  .40 
(4.)  Price               .              .              .  .  .40 

4.  Number  and  Distribution  of  Meals  .  .        40 

5.  Climate    .  .  .  .  .  .40 

SECTION  V. — PRESERVED  FOODS  .  .  .40 

1.  Liebig's  Extract    .  .  .  .  .40 

2.  Preserved  Meat     .  .  .  .  .41 

3.  Preserved  Vegetables          .  .  .  .41 

4.  Preserved  Milk     .  .  .  .  .41 

SECTION  VI. — EXAMINATION  OF  FOOD     .  .42 

1.  Animal  Food         .  42 

2.  Flour        ...  .45 

3.  Bread        ...  .45 

4.  Oatmeal   ....  .46 

5.  Milk          ......        46 

6.  Butter      ....  .47 

7.  CliL-c*/  .        47 


CONTENTS. 

PAGE 

......       48 

9.  Potatoes    .              .              .              .              .  .48 

10.  Tea                        .             .             .             .  .       48 

11.  Coffee       ......       48 

SECTION  VII. — THE  EFFECTS  OF   INSUFFICIENT   OR  UN- 
WHOLESOME FOOD  ON  PUBLIC  HEALTH      .  .49 

1.  Effects  of  Insufficient  Food              .              .  .49 

2.  Unwholesome  Food            .              .              .  .52 
(1.)  Putrid  Meat  .              .              .              .  .53 
(2.)  Diseased  Meat             .              .              .  .54 
(3.)  Unwholesome  Fish     .              .              .  .56 
(4.)  Unwholesome  Vegetable  Food               .  .56 

Spread  of  Disease  through  the  Agency  of  Milk  .        57 

Aphthous  Ulceration  of  the  Mouth      .              .  .57 

Outbreaks  of  Scarlet  Fever     .              .              .  .59 

,,         „   Diphtheria          .              .              .  .61 

„         „   Enteric  or  Typhoid  Fever             .  .61 

Regulations  for  Cow-sheds  and  Dairies  62 


CHAPTEE  III. 

AIR:    ITS    IMPURITIES,    AND   THEIR   EFFECTS   ON 
PUBLIC   HEALTH. 

SECTION  I. — COMPOSITION  OF  AIR  .  .  .63 

SECTION  II. — IMPURITIES  IN  AIR,  AND  THEIR  EFFECTS  ON 

PUBLIC  HEALTH  .  .  .  .64 

Different  kinds  of  Impurities  .  .  .  .64 

1.  Air  vitiated  by  Respiration  .  .  .66 

Minor  Effects  thereof  68 


CONTENTS.  XI 

PAGE 

Graver  Effects  thereof         .             .             .  .69 

Typhus     .              .              .              .              .  .70 

Phthisis  and  Lung  Affections           .              .  .71 

Hospital  Gangrene  and  Purulent  Ophthalmia  .        72 

2.  Air    rendered    impure    by    Sewage    and    Cesspool 

Effluvia               .              .              .              .  .72 

Nature  of  Impurities          .              .              .  .72 

Effects  thereof       .              .              .              .  .73 

Diarrhoea               .             .             .             .  .74 

Enteric  or  Typhoid  Fever  .              .              .  .74 

Cholera    ,              .              .              .              .  .75 

Diphtheria             .              .              .              .  .76 

Eisks  attending  Sewage-irrigation  .              .  76 

3.  Effluvia  from  decomposing  Animal  Matter  .  .77 
Effects  of  Effluvia  arising  from  Putrid  Kemains  .        77 
From  Graveyards               .              .             .  .77 
From  Manure  and  similar  Manufactories      ,  .77 

4.  Gases  and  Vapours  given  off  by — 

Alkali  Works    .....        78 

Chemical  Works             .              .              .  .78 

Brickfields         .              .              .              .  .79 

5.  The  Air  of  Marshes           .             .              .  .79 
Effects  thereof       .              .              .              .  .79 

6.  Air-impurities  in  certain  Trades  and  Occupations  .        80 
Mining     .              .              .              .              .  .        80 

Steel-grinding  and  other  Trades      .              .  .80 

Wool-sorters'  Disease          .              .              .  .81 

Dr.  Greenhow's  Inquiry  into  the  excessive  Mortality 

from  Lung-Diseases        .              .              .  .82 

Mr.  Simon's  Comments  thereon      .              .  .85 

Necessity  of  Sanitary  Inspection     .              .  .85 

Dr.  Ballard's  Inquiry  concerning  Trade  Nuisances  .        86 


Xll  CONTENTS. 

CHAPTER  IV. 

VENTILATION   AND   WARMING. 

PAGE 

Division  of  Subject    .              .              .  ,  .89 

SECTION  I. — THE  AMOUNT  OF  FRESH  AIR  REQUIRED  .       89 

Dr.  Parkes'  Experiments         .          -  .  .  .90 

Author's  Experiments  in  Prisons          .  .  .90 

Dr.  Angus  Smith's  Experiments           ..  .  .91 

Dr.  de  Chaumont's  Experiments           .  .  .91 
Circumstances  in  which  the  amount  of  Fresh-air  Supply 

must  be  increased  .              .              .  .  .92 

SECTION  II.— CUBIC  SPACE         .             .  .  .93 

Petteiikofer's  Experiments       .              .  .  .94 

Difficulties  of  preventing  injurious  Effects  when  the 

,  Cubic  Space  is  small            .              .  .  .95 

Different  Estimates    .              .              .  .  .95 

Summary  of  Results            ,    .              .  .  .97 

Remarks  thereon        .              .              .  .  .98 

SECTION  III. — NATURAL  VENTILATION    .  .99 

Forces  engaged  in                    .              .  .  .99 

Diffusion        .              .              .              .  .  .99 

Movements  of  Air  produced  by  Inequalities  of  Tem- 
perature   .              .              .              .  .  .100 

Perflation      .              .              .              .  .  .100 

Aspiration     .              .              .              .  .  .100 

Ventilation  by  open  Windows              .  .  .101 

Air-bricks  102 


CONTENTS.  XI 11 

PAGE 

Sheringliam  Valve      .              .  .  .  .102 

Transverse  Ventilating  Shafts  .  .  .102 

Mr.  Tobin's  System   .              .  .  .  .102 

Cowls             .              .              .  .  .  .103 

Louvres         ......      103 

Mr.  Sylvester's  Plan  .              .  .  .  .103 

Dr.  Arnott's  Plan       .              .  .  .  .104 

Mr.  Potts's  Plan         .              .  .  .  .104 

Mr.  Varley's  Plan      .              .  .  .  .104 

Mr.  M'KinnelTs  Plan               .  .  .  .105 

Dr.  Stallard's  Plan  105 


SECTION  IV. — ARTIFICIAL  VENTILATION  AND  WARMING   .     106 

Propulsion  and  Extraction,  or  the  plenum  and  vacuum 

Systems     .              .              .              .              .  .106 

Ventilation  by  open  Fire-places            .              .  .106 
Movement  of  Air  in  a  Koom  with  an  open  Fire-place    .      106 

Amount  of  Heat  which  passes  up  the  Chimney  .      108 

Galton's  Ventilating  Stoves     .              .              .  .108 

Boyle's  Ventilating  Grates       .              .              .  .109 

Shorland's  Manchester  Grate  .              .              .  .109 

Smoke-consuming  Grates    "    .              .              .  .110 

Economisers  .              .              .              .              .  .110 

Gas  Stoves    .             .             .              .              .  .111 

Faults  of  Common  Stoves        .              .              .  .111 

Construction  of  Stove  Smoke-flues       .              .  .112 

Chimney  Ventilators  .              .              .              .  .112 

Fresh-air  Inlets  and  Extraction -flues    .              .  .112 

Mr.  Ritchie's  Plan  of  Ventilation  and  Warming  .      113 

Ventilation  and  Warming  by  Hot- water  Pipes  .  .113 

Ventilation  by  Furnaces  in  Extraction-shafts    .  .114 

Combination  of  Methods  114 


XIV  CONTENTS. 

PAGE 

Ventilation  of  Mines                .              .  .  .115 

Ventilation  of  Ships                 .              .  .  .115 

Ventilation  by  Gaslights         .              .  .  .116 

Extraction  by  Fan  or  Screw    .              .  .  .117 

Ventilation  by  Propulsion       .              .  .  .117 

Van  Hecke's  System  .              .             .  .  .117 
Relative  Merits  of  the  two  Systems  of  Ventilation — 

viz.  Extraction  and  Propulsion         .  .  .118 

Relative  Position  of  Inlets  and  Outlets  .  .118 

Construction  of  Foul-air  Flues              .  .  .119 

Sectional  Area  of  Inlets  and  Outlets    ,  120 


CHAPTER  V. 

EXAMINATION  OF  AIR  AND  VENTILATION. 

SECTION    I.  —  EXAMINATION    AS    REGARDS  VENTILATING 

ARRANGEMENTS.             .            .             .  .122 

Cubic  Space  .              .              .              .              .  .122 

Relative  Position  and  Size  of  Outlets  and  Inlets  .      123 

Air-currents  .              .              .              .              .  .123 

Use  of  Anemometer  .              .              .              .  .124 

Amount  of  Fresh-air    Supply  best*  indicated    by  the 

Amount  found  to  be  issuing  through  the  Outlets  .      125 

Proper  time  for  Examination                .              .  .126 

Method  of  Procedure               .              .             .  .126 

SECTION  II.—  EXAMINATION  BY  THE  SENSES  .     126 

SECTION  III. — CHEMICAL  EXAMINATION               .  .127 

1.  Carbonic  Acid  127 


CONTENTS.  XV 

PAGE 

Description  of  Pettenkofer's  Method  .  .127 

Dr.  Angus  Smith's  Method              .  .  .132 

2.  Organic  Impurities              .              .  .  .133 

3.  Ammonia               .              .              .  .  .134 

SECTION  IV. — MICROSCOPICAL  EXAMINATION  .  .135 

Pouchet's  Aeroscope  .             .              .  .  .135 

SECTION  V. — EXAMINATION  AS  REGARDS — 

1.  Temperature          .              .              .  .  .135 

2.  Moisture                .              .              .  .  .135 
Dry  and  "Wet  Bulb  Thermometers  .  .  .136 
Table  of  Relative  Humidity            .  .137 
Concluding  Remarks          .              .  .  .138 


CHAPTER  VI. 

WATER. 

SECTION  I. — SOURCES    .             .  .  .             .139 

Rain  Water   .             .             .  .  .              .139 

Amount  of  Water  derivable  from  Rainfall,  and  Condi- 
tions influencing- the  same  .  .  .              .140 

Water  from  Wells  and  Springs  .  .              .141 

River  Water.              .              .  .  .143 

Lake  Water  .              .              .  .  .             .143 

Classification  of  Potable  Waters  .  .              .144 

SECTION   II. — QUANTITY   REQUIRED  FOR    HEALTH   AND 

OTHER  PURPOSES    .             .  .  .             .144 

Different  Estimates    .              .  .  .145 

Waste  of  Water  147 


XVi  CONTENTS. 

PAGE 

SECTION  III.— MODES  OF  SUPPLY           .  .  .147 

Wells  and  Borings     .              .              .  .147 

Artesian  Wells           .              .              .  .  .148 

Conditions  affecting  the  yield  of  Wells  .  .149 

Norton's  Tube-well    .                            .  .  .150 

Waterworks      .                        .              .  .  .150 

Gathering-grounds      .              .             .  .  .151 

Average  Annual  Kainfall        .              .  .  .152 

Channels  of  Gathering-grounds             .  .  .152 

Reservoir       .              .             ..              .  .  .152 

Construction  and  Adjuncts  thereof       .  .  .153 

Construction  of  Aqueduct  and  Distributing  Conduits     .      154 

House  Service-pipes   .              .              .  .  .155 

Substitutes  for  Leaden  Pipes  .              .  .  .155 

Conditions  affecting  the  Size  of  Conduits  .  .155 

Intermittent  and  Constant  Systems  of  Supply  .  .156 

Relative  Merits  and  Disadvantages  thereof  .  .156 

Waste-preventers        .              .              .  .  .157 

Water-cisterns             .             .              .  .  .157 

Protection  of  Water-pipes  and  Mains  .  ,  .158 

SECTION  IV. — PURIFICATION  OF  WATER  .  .  .159 

Filter-beds    .              .              .              .  .  .159 

Domestic  Filters  and  Filtering  Media  .  .  .160 

Crease's  patent  Tank  Filter    .              .  .  .162 

Cleansing  of  Filters    .              .              .  .  .162 

Clark's  Process  of  Purification               .  .  .162 

Porter-Clark  Process  .              .              .  .  .163 

Other  Purifying  Agents           .              .  .  .163 

SECTION  V. — SOURCES  OF  POLLUTION      .  .  .164 

How  Shallow  Wells  become  polluted  .  .  .164 


CONTENTS.  XV 11 

PAGE 

How  public  Supplies  become  polluted  .  .  1G6 

Dangers  of  direct  Communication  of  Water-mains  with 

Closets       .  .  .  .  .  .166 

Dangers  attaching  to  Cisternage  .  .  .167 

Dr.  Buchanan's  Experiments  on  In-currents  into  leaky 

Mains        .  '  .  .  .  .  .      167 

CHAPTER    VII. 

WATER   ANALYSIS. 

SECTION  I. — COLLECTION  OF  SAMPLES     .  .  .169 

SECTION  II. — PHYSICAL  EXAMINATION     .  .  .171 

SECTION  III. — MICROSCOPICAL  EXAMINATION       .  .172 

SECTION  IV.— CHEMICAL  EXAMINATION  .  .  .173 

1.  Qualitative  Examination    .  .  .  .173 

2.  Quantitative  Analysis         .  .  .  .179 
Practical  Deductions           .              .              .              .195 

CHAPTER   VIII. 

IMPURE   WATER,    AND   ITS   EFFECTS   ON   PUBLIC   HEALTH. 

SECTION  I. — MINERAL  IMPURITIES          .  .  .199 

Effects  of  excessive  Hardness  .  .  .  .200 

Goitre  ......      200 

Lead-poisoning  .  .  .  .  .201 

SECTION  II. — VEGETABLE  IMPURITIES  AND  THEIR  EFFECTS     202 

SECTION  III. — ANIMAL  IMPURITIES         .  .  .203 

1.  Instances  of  Propagation  of  Cholera  by  means  of 

Polluted  Water  204 


XV111  CONTENTS. 

PAGE 

2.  Propagation  of  Enteric  or  Typhoid  Fever     .  .208 
(1.)  Epidemic  at  Winterton            .              .  .     209 
(2.)          „         „  Guildford             .              .  .211 
(3.)          „         „  Terling  .                            .  .211 
(4.)          „         „  Sherborne            .              .  .212 
(5.)  Outbreak  at  Cains  College,  Cambridge  .     213 
(6.)  Epidemic  at  Lewes     .             .             .  .217 
Specific  outbreaks  of  Enteric  Fever              .  .217 

(a)  Outbreak  at  Nunney             .             .  .218 

(6)          „        „  Over  Darwen     .              .  .218 

(c)  „        „  Lansen               .  .     219 

(d)  „        „  Caterham          .             .  .220 

(e)  „        „  Bangor                             .  .     223 
Outbreak  at   Evesham  due  to  polluted  aerated 

waters  .....     224 

Enteric  Fever  in  Rural  Districts               .  .225 

3.  Diphtheria             .              .              .              .  .226 

4.  Dysentery              .              .              .              .  .226 

5.  Diarrhoea               .....     226 
Concluding  Remarks          .              .              .  .227 


CHAPTER    IX. 

DWELLINGS. 

SECTION  I— SITE          .             .             .  .  .229 

SECTION  II.— STRUCTURAL  ARRANGEMENTS  .     231 

Foundations  .              .              .              .  .  .231 

Drains  ......     232 

Cesspools       .              .              .              .  .  .234 

Wells             .              .              .              .  .  .235 

How  to  prevent  Dampness  of  Walls    .  .  .235 


CONTENTS.  xix 

PAGE 

Situation  and  Construction  of  Water-closets      .  .230 

Ventilation  of  House-drains,  etc.          .             .  .238 

SECTION  III. — DWELLINGS  FOR  THE  POORER  CLASSES  .     240 

Plans  and  Estimates  .....     240 

Dwellings  unfit  for  Habitation              .              .  .242 

Dwellings  of  Rural  Labourers               .              .  .244 

Surface  Crowding  in  Large  Towns       .  .247 

SECTION  IV.— SANITARY  INSPECTION  OF  DWELLINGS  .     248 

Diseases  traceable  to  Sanitary  Defects  .              .  .248 

Sanitary  Defects  in  and  around  Dwellings        .  .250 

Mode  of  Inspection    .              .             .             .  .254 


CHAPTER    X. 

HOSPITALS. 

Preliminary  Remarks  with  regard  to  Site          .  .259 

SECTION  I. — PAVILION  HOSPITALS           .             .  .260 

General  Plan  .....     260 

Conditions  which  determine  the  Size  and  Form  of  a 

Ward        .             .             .              .              .  .262 

The  Number  of  Patients         .              .              .  .262 

The  Floor  and  Cubic  Space    .             .              .  .262 

Remarks  concerning  the  Cubic  Space  of  Workhouses     .     262 

Floor  Space  in  different  Hospitals        .             .  .263 

Ventilation  and  Structural  Details  of  a  Ward  .  .263 

Furniture      .              f              .              .              .  .265 

Ward-offices  .              .              .              .              .  .266 

Administrative  Buildings                      .              .  .268 

Exercising  Grounds,  etc.          .              .              .  .269 


XX  CONTENTS. 

PAGE 

SECTION  II. — COTTAGE  HOSPITALS          .  .  .269 

Kegulations  and  Management  thereof  .  .  .270 

Cost  of                        .              .              .  .  .271 

Structural  Details       .              .              .  .  .271 

SECTION   III. — HOSPITALS    FOR    CASES    OF    INFECTIOUS 

DISEASE             .             .             .  .  .272 

Memorandum  of  Privy  Council  relating  thereto  .     272 

Conditions  affecting  Site          .             .  .  .273 

Katio  of  Beds  to  Population    .              .  .  .274 

Actual  Cost  of  different  Hospitals         .  .  .275 

Structural  Details       .              .              .  .  .276 

Tents  and  Huts          .              .              .  .  .280 

Ground-plans              .              .              .  .  .281 

Management  of  Infectious  Hospitals     .  .  .284 

Ambulances  .              .              .              .  .  .284 

Hospital  Ships            .              .              .  .  .285 

SECTION  IV.— MORTUARIES         .             .  .286 

Clauses  in  Public  Health  referring  to  .  .  .286 

Cost  and  Structural  Details  287 


CHAPTER   XL 

REMOVAL  OF  SEWAGE. 

What  is  meant  by  the  term  Sewage     .  .  .288 

Mr.  Simon's  Kemarks  on  the  Prevalence  of  Filth  .     289 

Different  Methods  of  Sewage-removal  .  .  .291 

SECTION  I. — THE  WATER  SYSTEM  .  .291 

Construction  of  Drains  and  Sewers      .  .  .292 

Pipe-sewers,  their  Advantages  .  .  .293 


CONTENTS.  XXI 

PAGE 

House-drains  .  .  .  .  .295 

Ventilation  of  Sewers  and  Drains         .  .  .295 

Flushing  of  Sewers     .  .  .  .  .298 

Shone's  Pneumatic  System      .  .  .  .300 

Traps  .....  .     301 

Water-closets  .....     304 

Trough-closets  .  .  .  .  .305 

Tumbler-closets          .  .  .  .  .305 

Bristol  Eject  .....     306 

Latrines         ......     306 

Intercepting  Tanks    .  .  .  .  .307 

Urinals          ......     308 

SECTION  II. — THE  PRIVY  OR  MIDDEN  SYSTEM     .  .     308 

SECTION  III. — THE  PAIL  SYSTEM  .  .  .310 

The  Goux  System      .....     310 
Other  Systems  .  .  .  .  .311 

Disposal  of  Pail-contents  and  Town-refuse         .  .312 

SECTION  IV.— THE  DRY  SYSTEM  .  .  .315 

Moule's  Earth-closet  .  .  .  .316 

Other  Dry  Closets      .  .  .  .  .318 

SECTION    V.  —  LIEURNUR'S    AND    OTHER    CONTINENTAL 

SYSTEMS  .....     319 

SECTION  VI. — SYSTEMS  BEST  SUITED  FOR  RURAL  DISTRICTS     321 
SECTION  VII.— DISPOSAL  OP  SLOPS         .  .  .325 

Village  Drainage        .  .  .  .  325 

Drainage  of  Scattered  Houses  .  .  .  .326 

SECTION  VIIL— PUBLIC  SCAVENGING      .  .  .327 

Duties  of  Sanitary  Authorities  328 


XX11  CONTENTS. 

PAGE 

Kemoval  of  House-refuse         .  .  .  .328 

Street  Scavenging      .  .  .  .  .330 

Advantages  of  Wood-pavement  and  Asphalt  in  Street- 
construction  331 


CHAPTER   XII. 

• 

PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

River-pollution           .              .             .              .  .332 

SECTION  I. — TOWN-SEWAGE       .             .             .  .333 

Composition  and  Amount  thereof         .              .  .334 

Analysis  of  Urine  and  Faeces  .              .              .  .334 

Manurial  Value  of                    .              .              .  .335 

SECTION    II. — SCHEMES    FOR    THE    PURIFICATION  AND 

UTILISATION  OF  SEWAGE              .             .  .336 

1.  Precipitation  Processes        .             .              .  .336 
Precipitation  by  Lime         .              .              .  .337 
Blyth's  Process       .              .              .              .  .337 
Holden's  Process    .              .              .              .  .337 
Bird's  Process         .              .             .             .  .338 
The  « A  B  C "  Process        .              .              .  .338 
The  Phosphate  Process        .              .              .  .3.38 
Hille's  Process        .              .              .              .  .339 
General  Scott's  Process        .              .              .  .339 
Whitthread's  Process            ....      340 
Anderson's  Process               .              .              .  .340 

2.  Filtration  Processes              .              .              .  .341 
Simple  Filtration  .              .              .              .  .341 
Carbon  Filtration,  or  Weare's  Process            .  .341 
Upward  Filtration .....     341 


CONTENTS.  XX111 

PAGE 

Intermittent  Downward  Filtration  .  .  .341 

How  carried  on  at  Merthyr-Tydfil   .  .  .342 

„         „         „      Kendal  ....     343 

3.  Irrigation  .  .  .  .  .'    343 

Details  concerning  Sewage  farming  .  .  .344 

Table  of  Average  Results  of  the  different  Processes  .     345 

Monetary  Details    .  .  .  .  .347 

SECTION  III. — TREATMENT  OF  VILLAGE  SLOPS         .  .     349 

Various  Methods        .              .              .              .  .349 

Denton  and  Field's  Automatic  Sewage-meter  Tank  .     350 

Irrigation  and  Intermittent  Downward  Filtration  .     351 

Sub-Irrigation             .              .              .              .  .351 

CHAPTER   XIII. 

THE  EFFECTS  OF  IMPROVED  DRAINAGE  AND  SEWERAGE 
ON  PUBLIC  HEALTH. 

SECTION  I. — THE  EFFECTS  OF  DAMPNESS  OF  SOIL  .     352 

Dr.  Buchanan's  Inquiries  concerning  the  Production  of 
Phthisis    ......     352 

Dr.  Buchanan's  Conclusions    .  .  .  .354 

Dr.  Bowditch's  Researches       .  .  .  .355 

Other  Diseases  influenced  by  Dampness  of  Soil  .     356 

SECTION  II. — SANITARY  ASPECTS  OF  THE  WATER-CARRIAGE 

SYSTEM  OF  EXCRETAL  REMOVAL       .  .  .357 

Enteric  or  Typhoid  Fever       .  .  .  .357 

Influence  on  general  Death-rate  .  .  .359 

SECTION  III. — SANITARY  ASPECTS  OF  SEWAGE  IRRIGATION     359 

Objections  which  have  been  raised  not  tenable  .     360 

General  Conclusions  .  361 


XXIV  CONTENTS. 

CHAPTER   XIV. 

PREVENTIVE  MEASURES — DISINFECTION. 

PAGE 

Preliminary  Keniarks  on  Infectious  Diseases     .  .362 

Mr.  Simon's  Views     .              .              .              .  .365 

SECTION  I. — MODE  OF  PROPAGATION  or  EPIDEMIC  DISEASES, 

AND  THE  PRECAUTIONARY  MEASURES  INDICATED  .     369 

Cholera          .              .              .              .              .  .369 

Enteric  or  Typhoid  Fever        .              .              .  .372 

Typhus  Fever            .             .              .              .  .373 

Relapsing  Fever          .              .              .              .  .375 

Smallpox      .              .                                         .  .375 

Scarlet  Fever              .              .              .              .  .377 

Measles          .              .              .              .              .  .378 

Whooping-cough         .              .              .              .  .378 

Diphtheria.  .              .              .              .  .379 

Diarrho3a       .                            .              .              .  .381 

SECTION  II. — DISINFECTANTS      .             .             .  .382 

Heat  and  Cold  .....     383 

Charcoal         .              .              .              .              .    '  .      383 

Chlorine         .              .              .            ..              .  .384 

Nitrous  Acid .              .              .              .              .  .384 

Iodine             .              .              .              .              .  .385 

Bromine  ....      385 

Sulphurous  Acid  Gas               .              .              .  .385 

Carbolic  Acid              .              .              .              .  .385 

Terebene         .              .              .              .              .  .386 

Cupralum       .              .              .              .  .386 

Sanitas  387 


CONTENTS.  xxv 

PAGE 

Condy's  Fluid  .  .     387 

Chloralum      .  .  .  .  .  .387 

Chloride  of  Liine  .  .  .  .  .387 

M'DougalTs  Powder  .  .      387 

Sulphate  of  Copper  .  .387 

Chloride  of  Zinc  .  .  .  .  .388 

Ferrous  Sulphate  .  .  .  .  .388 

Jeye's  Disinfectant  .  .  .  .  .388 

Cooper's  Salts  .  ...      388 

Potassium  Bichromate  .  .  .  .388 

SECTION  III. — PRACTICAL  DISINFECTION  .  .     389 

Hygiene  of  the  Sick-room       .  .  ..  .     389 

Disinfection  of  Empty  Kooms  and  Uninhabited  Places  .     390 
Disinfection  of  Clothing,  Bedding,  etc.  .  .390 

Hot-air  Chambers       .  .  .  .  .391 

Disinfection  of  "Water-closets,  Urinals,  etc.        .  .391 

Disinfection  of  the  Dead  Body  .  .392 


CHAPTER  XV. 

VITAL   STATISTICS. 

SECTION  I.— SOURCES  OF  INFORMATION    .  .             .     394 

1.  The  Census            .              .              .  .              .395 

2.  Calculated  Estimates  of  Population  .              .398 

3.  Registration           .              .              .  .              .401 

(«)  Registration  of  Births              .  .              .402 

(b)  „           „     Marriages        .  .              .     402 

(c)  „           „     Deaths  .      402 

SECTION  IL — CLASSIFICATION  404 


SECTION  III  .  ,404 

1.  P.irtli  .  . 

2.  Marriai^e-i  .....      -lor, 

3.  Mortality                 .               .  .       h><; 
(1.)  Total  Annual  1  Vat  lira  t<                          .  .       |o<; 
(2.)  Zymotie  IValh  r.it.-       .               .               .  '.411 
(3.)  Kate  Of  Infant  Mortality  .      •!  I -J 
(4.)  Death-rate  at  various  Croups  of  Ages      .  .411 
(5.)  Death-rate  of  Persons  engaged   in  various 

pations        .  .  .  .  .413 

(6.)  Death-rates  in  tlillVivnt  Loral  .  .Ill 

(7.)  Mortality  in  relation  to  Seas  .  .      II.. 

4.  Longevity  .  .  .  .  .418 
(1.)  Mean  Age  at  Death     .... 

(2.)  Expectation  of  Life  or  Mean  After-Lifetime  at 

Various  Ages  .  .  .  .117 

5.  Morbidity  ..... 
Concluding  Rein  .  .  .  .418 


CHAPTER  XVI. 

THE  DUTIES  OF  MEDICAL  OlTKT.Rs  OF  IM'.U.TH. 

Conditions  of  Appointment     .  .  .  .481 

Rules    and    Regulations  issued    hy  Loeal   Government 
Board        .  .  .  .  .  .422 

SECTION  I. — NATURAL  CONDITIONS  A  m 

HE  POPULATION  CON  \  THE  DISTRICT       .     425 

Geological  Conditions  .  .  .  .425 

To|>(>L,rra pineal    ,, 


xxvii 

PAGE 

:-I'ly  .  ...      425 

CliinaU-          .  .  .      425 

SECTION   II.— ARTIFICIAL  CONDITIONS     .  .  .     426 

•ati"iis    ......      426 

'MY       .....      426 

I  Tb"  ....     427 

rage,  etc.          ....     428 

Factories,  Workshops,  etc.  .  .  .428 

SECTION  III.— VITAL  STATISTICS  .  .  .     429 

Information  with  respect  to  Returns,  etc.          .  .     429 

SECTION  IV. — DUTIES  REQUIRED  or  THE  HEALTH  OFFICER 

FOR   THE    EFFICIENT    EXECUTION    OF    THE    SANITARY 

ACTS         .  .  .  .  .  .433 

Practical  Hints  on  the  more  important  Sections  of  the 

Public  Health  Act,  1875     .  .  .  .434 

•  rage  and  Drainage  ....     434 

I'rivii-s  Wi»t«  r-< -Insets,  etc.       ....     434 

Scavenging  and  Cleansing       ....     434 

Offensive  Ditches  and  Collections  of  Matter      .  .435 

r-supply  .....      435 

Regulation  of  Cellar-Dwellings  and  Lodging-houses       .     436 
Nuisances      ......     436 

Remarks  on  Overcrowding      .  .  .438 

Offensive  Trades         .  .  .  .  .441 

Unsound  Meat  .  .  .  .  .445 

,  Mortuaries,  «  .     446 

Other  Clauses  of  PuMir  Health  Act  1875,  of  Interest 

to  Medical  Oil  iltl.  .  .  .449 

by  PuMi<    Il.alth  Act  1876  ,      450 


XXV1U  CONTENTS. 

PAGE 

Artisans' Dwellings  Act,  1875  .  .  .450 

By-laws          .              .              .  .  .  .451 

Legal  Proceedings       .              .  .  .  .451 

Koutine  of  Duty         .              .  .  .  .452 

Duties  of  Sanitary  Inspectors  .  .  .  .452 

Reports          .              .              .  .  .  .456 

Official  Conduct  457 


APPENDIX. 

OFFICIAL  MEMORANDA  AND  OTHER  DATA     .  .  .459 

I.  The  Dairies,  Cow-sheds,  and  Milk -shops  Order  of 

1879      .  .  .  .  .  .459 

II.  Memorandum  on  Hospital  Accommodation  .     461 

III.  Ambulances          .  .  .  .  .461 

IV.  Rules  for  the  Management  of  Hospitals  for  Infec- 

tious Diseases     .  .  .  .  .462 

V.  Memorandum  with  respect  to  the  Steps  to  be  taken 

in  Places  where  Smallpox  is  Epidemic      .  .463 

VI.  Memorandum  with  respect  to  Public  Vaccination     .     467 
VII.  Memorandum  with  respect  to  Re- Vaccination  .     471 

VIII.  Memorandum  with  respect  to  Vaccination  from  Calf- 
Lymph  .  .  .  .  .  .     472 

IX.   General  Memorandum  on  the  Proceedings  which  are 
advisable  in  Places  attacked  or  threatened  by  Epi- 
demic Disease     .  .  .  .  .473 

X.  Suggestions  by  the  Society  of   Medical  Officers  of 
Health  for  Preventing  the  Spread  of  Infectious  or 
Contagious  Diseases         .  .  .  .477 

XI.  Memorandum  with  respect  to  Returns  of  Deaths 
from  Registrars,  and  Returns  of  Pauper  Sickness 
from  District  Medical  Officers  480 


CONTENTS.  XXIX 

PAGE 

XII.  Memorandum  with  respect  to  Annual  Reports  of 

Medical  Officers  of  Health  .  .  .482 

XIII.  Clerk's  Return  of  New  Cases  of  Sickness  occurring 

amongst  Paupers  .  .  .  .485 

XIV.  Notice   of   Cases  of    Infectious    Disease    occurring 

amongst  Paupers  .  .  .  .486 

XV.  Statistical  Tables  arranged  by  the  Society  of  Medical 

Officers  of  Health,  London  .  .  .     487 

XVI.  Comparison  of  Metrical  with  English  Measures        .     499 

XVII.  List  of  Apparatus  and  Re-agents  for  Analysis  .     500 

INDEX  503 


CHAPTEK  L— INTEODUCTOEY. 

PUBLIC    HEALTH    AND    PREVENTABLE    DISEASE. 

PUBLIC  HYGIENE  may  be  defined  as  that  branch  of  sani- 
tary science  which  concerns  the  physical  condition  of 
communities.  It  embraces  a  consideration  of  the  various 
influences  operating  upon  society,  whether  for  its  material 
good  or  its  actual  deterioration,  with  the  view  of  extending 
the  former,  and  preventing,  or  ameliorating,  as  far  as  pos- 
sible, the  effects  of  the  latter.  It  involves  the  enactment 
of  laws  by  which  the  safety  of  the  whole  may  be  protected 
against  the  errors  of  a  part,  and,  above  all,  it  aims  at  the 
prevention  of  disease  by  the  removal  of  its  avoidable 
causes.  In  a  wide  sense,  therefore,  the  science  of  public 
hygiene  enlists  the  services  of  the  people  themselves  in 
continuous  efforts  at  self-improvement ;  of  the  teachers  of 
the  people,  to  inculcate  the  best  rules  of  life  and  action ; 
of  physicians  in  preventing  as  well  as  curing  disease;  and 
of  lawgivers,  to  legalise  and  enforce  measures  of  health- 
preservation.  But  while  it  is  the  special  province  of  the 
medical  profession,  as  guardians  of  the  public  health,  to 
study  the  causes  of  physical  deterioration  and  disease, 
and  to  point  out  how  far  these  causes  may  be  controlled 
or  averted,  the  general  well-being  of  the  people  must 
mainly  depend  on  their  own  exertions  and  self-restraint, 
Sanitary  improvements  in  man's  material  surroundings 
will  not  compensate  for  social  transgressions  against 


2  PUBLIC  HEALTH  AND 

of  morality;  for  public  virtue  is  essential  to  public  health, 
and  both  to  national  prosperity. 

The  time,  however,  has  gone  by  when  people  can  be 
dragooned  into  cleanliness  or  be  made  virtuous  by  police 
regulations,  and  hence  it  is  that  the  most  thoughtful 
among  practical  reformers  of  the  present  day  base  their 
hopes  of  sanitary  progress  on  the  education  of  the  masses 
as  the  real  groundwork  of  national  health.  The  people 
must  be  taught  that  good  conduct,  personal  cleanliness, 
and  the  avoidance  of  all  excesses,  are  the  first  principles 
of  health-preservation ;  that  mental  and  physical  training- 
must  go  hand  in  hand  in  the  rearing  and  guidance  of 
youth ;  and  that  morality  does  not  consist  so  much  in  a 
blind  observance  of  the  formulae  of  empty  creeds  as  in  a 
hearty  submission  to  precepts  of  health.  Nor  is  this  all. 
They  must  be  interested  systematically  in  the  general 
results  of  sanitary  progress,  and  become  more  intimately 
acquainted  with  the  social  and  material  causes  by  which 
it  is  impeded.  Unless  a  knowledge  of  these  fundamental 
principles  of  hygiene  be  widely  disseminated  amongst 
them,  it  is  in  vain  to  expect  that  legislative  enactments, 
however  well  devised,  will  succeed  in  raising  the  standard 
of  public  health  to  any  considerable  extent.  But  there 
are  hopeful  signs  of  progress  even  in  this  direction.  The 
teaching  of  physiology  and  the  laws  of  health,  which 
is  being  gradually  introduced  into  many  schools,  will 
doubtless  be  productive  of  much  good  amongst  the  rising 
generation ;  while  the  large  share  of  attention  which  the 
discussion  of  sanitary  questions  is  already  receiving  in  the 
public  press  is  the  best  evidence  of  the  steady  growth  of 
intelligent  conviction  as  regards  all  matters  affecting  the 
preservation  of  health  and  the  prevention  of  disease. 

Taking,  then,  this  wide  view  of  the  scope  of  public 
hygiene,  it  will,  I  trust,  prove  alike  interesting  and  useful 
if,  by  way  of  introduction,  I  give  a  brief  historical  sketch 


PREVENTABLE  DISEASE.  6 

of  its  various  phases,  and  more  particularly  of  its  progress 
during  recent  years.  For  sanitary  science,  in  the  broad 
sense  of  the  term,  is  knit  up  with  the  life-history  of  even' 
nation,  and  enters  largely  into  the  history  of  civilisation. 
It  figures  prominently  in  the  Mosaic  code  of  the  Jewish 
race,  and  its  instructions  and  preventive  measures,  as 
exemplified  in  that  code,  have  accounted  largely  for  the 
greater  comparative  longevity  of  the  Jews,  for  their  extra- 
ordinary immunity  from  the  recurring  epidemics  of  the 
Middle  Ages,  and  for  the  wide-spread,  though  silent  in- 
fluence which  they  have  long  exercised,  and  still  exercise 
to  the  present  day. 

Or  let  us  glance  at  those  grand  old  Greeks  who  have 
left  us  such  a  rich  store  of  philosophy,  literature,  and  art. 
It  is  true  that  though  their  sanitary  code,  propounded  by 
Lycurgus,  was  severe  and  cruel,  yet  the  means  which  they 
adopted  in  the  care  and  cultivation  of  their  bodily  phy- 
sique, and  the  development  of  their  intellectual  faculties, 
miide  them  the  civilisers  of  the  old  world  and  the  exem- 
plars of  modem  times.  But  the  Greeks,  with  all  their 
wisdom  and  physical  culture,  knew  very  little  of  the  causes 
of  disease  as  it  affects  communities,  and  they  accepted  the 
terrible  epidemics  with  which  they  were  visited  as  mani- 
festations of  offended  deities,  or,  at  the  best,  as  afflictions 
which  could  neither  be  avoided  nor  prevented.  Their 
decline  and  fall  as  a  nation  were  due  to  the  luxury  into 
which  they  lapsed,  and  the  lax  morality  which  ultimately 
became  their  ruin  and  opprobrium. 

Referring,  now,  to  the  Romans,  the  other  powerful 
nation  of  antiquity,  we  find  that  though  they  contributed 
but  little  to  sanitary  science,  they  have  left  some  wonder- 
ful examples  of  sanitary  engineering  on  a  large  scale. 
Their  Cloaca  Maxima,  for  example,  and  the  aqueduct  for 
rnnveyiiuj  water  from  the  hillsides,  some  thirty  miles  from 
Rome,  to  the  city,  were  works  of  such  stupendous  magni- 


4  PUBLIC  HEALTH  AND 

tude  that  they  have  seldom  been  equalled  or  surpassed 
even  at  the  present  day.  But  the  Eoman  Empire,  like 
that  of  the  Greeks,  was  destined  to  pass  away,  and  those 
who  have  studied  the  social  causes  of  its  decay  attribute 
its  ultimate  decline  in  no  small  degree  to  the  epidemics 
which  repeatedly  devastated  the  population  in  the  early 
centuries  of  the  Christian  era. 

We  next  pass  on  to  what  have  been  termed  the  dark 
or  Middle  Ages,  and  to  the  health  history  of  England.  The 
accounts  at  first  are  very  meagre,  but  when  they  become 
more  numerous  and  reliable  they  tell  us  of  frequent  visit- 
ations of  plague,  pestilence,  and  famine — mixed  up  with 
stories,  strange  and  incredible,  of  armies  fighting  in  the 
air,  showers  of  blood,  terrible  earthquakes,  and  the  like — 
all  of  them  showing  how  deep-rooted  was  the  belief  in  the 
supernatural  as  regards  epidemic  disease  and  its  causes. 
If,  however,  we  look  at  the  habits  and  habitations  of  our 
forefathers,  we  have  no  difficulty  in  accounting  for  the 
fearful  mortality  which  prevailed  amongst  them.  Personal 
cleanliness  was  utterly  neglected.  Clothing  was  immo- 
derately thick  and  warm,  and  was  seldom  changed  night 
or  day.  The  diet  was  coarse,  consisting  chiefly  of  flesh 
meats  highly  seasoned.  Strong  wine  or  ale  was  drunk 
early  in  the  morning,  and  often  far  into  the  night ;  in 
short,  gluttony  and  intemperance  were  prominent  charac- 
teristics of  the  sturdy  fighting  Briton  of  mediaeval  times. 

Then,  as  regards  his  dwelling,  we  find  that  the  towns 
and  villages  were  composed  for  the  most  part  of  hovels, 
with  mud  walls  and  thatched  roofs.  "  The  floors  of  the 
houses,"  to  quote  from  a  well-known  letter  of  the  learned 
Erasmus,  "  were  generally  made  with  loam  strewn  with 
rushes,  constantly  put  on  fresh  without  removing  the  old, 
lying  there  in  some  cases  for  twenty  years,  concealing 
fish  bones,  broken  victuals,  and  other  filth,"  so  that  one 
can  quite  credit  him  when  he  says  farther,  "  If  even 


PREVENTABLE  DISEASE.  5 

twenty  years  ago  I  had  entered  into  a  chamber  which  had 
been  uninhabited  for  some  months,  I  was  immediately 
seized  with  fever."  The  streets  were  unpaved,  generally 
covered  with  clay  and  rushes,  concealing  all  sorts  of 
abominations ;  moreover,  they  were  dark,  narrow,  and 
tortuous,  and  without  sewers  or  drains.  The  rural  popu- 
lation, on  the  other  hand,  were  scattered  in  slight  hovels 
over  wild  woods,  dreary  wastes,  and  undrained  marshes, 
so  that  ague  and  rheumatism  were  always  rife  amongst 
them,  and  in  times  of  scarcity,  which  were  common  enough, 
they  were  sure  to  suffer  from  famine.  Add  to  all  this, 
that  there  was  constant  fighting  of  some  sort  going  on. 
Kings  were  warring  against  powerful  subjects  or  foreign 
foes.  Cities  and  towns  wrere  walled-in  fortresses ;  and 
the  roads  were  beset  with  marauders  and  highwaymen. 
Dogberries  watched  the  streets  but  did  not  ward  them, 
bravoes  stabbed,  burglars  were  plentiful,  and  amongst  all 
classes  life  was  held  very  cheap.  Those,  indeed,  were 
days  in  which  Mr.  Darwin's  doctrine  of  survival  of  the 
fittest  was  exemplified  to  the  fullest  extent ;  the  weakly 
went  to  the  wall,  and  left,  on  the  whole,  only  those  of 
iron  constitutions  to  perpetuate  a  brave,  hardy,  and  push- 
ing race,  which  increased  in  numbers  slowly,  if  at  all,  for 
centuries. 

We  thus  see  that  conditions  inimical  to  health  were 
abundant  everywhere.  The  walled-in  cities  were  highly 
favourable  to  overcrowding  and  stagnant  air;  the  large 
armies,  which  were  in  constant  motion,  conduced  greatly 
to  the  spread  of  epidemic  disease ;  while  personal  un- 
cleanliness  and  intemperate  habits  made  the  people  ready 
victims  of  disorders  of  all  kinds.  It  is  not  surprising, 
therefore,  that  fevers  and  devastating  epidemics  were 
prevalent ;  and  as  instances  in  point,  I  may  mention  the 
following,  which  are  recorded  on  the  authority  of  Dr. 
Guy  in  his  excellent  work  on  Public  Health : — For 


6  PUBLIC  HEALTH  AND 

example,  in  the  twelfth  century,  there  were  fifteen  wide- 
spread epidemics  and  many  famines ;  in  the  thirteenth 
century,  twenty  epidemics  and  nineteen  famines ;  and  in 
the  early  part  of  the  fourteenth  century  there  were  eight 
epidemics  and  more  famines.  And  these  epidemics,  it 
should  be  remembered,  were  not  local  outbreaks  appearing 
only  here  and  there,  but  they  spread  so  far  and  wide  that 
each  and  all  of  them  were  regarded  as  visitations  of 
national  disaster. 

And  now  we  come  to  the  fatal  year  of  1348,  when 
the  Black  Death  or  Great  Mortality,  as  it  was  called, 
first  appeared  in  England.  It  is  believed  to  have  been 
an  aggravated  outbreak  of  the  Oriental  Plague,  which  was 
then  devastating  Europe  as  it  had  devastated  the  East. 
•It  was  an  eminently  contagious  disease — imported,  no 
doubt,  in  the  first  instance ;  but  when  once  it  gained  a 
footing  on  our  shores,  it  spread  with  such  terrible  rapidity, 
that  within  a  few  months  almost  every  town  and  village 
throughout  the  country  had  been  attacked,  and  in  some 
places  only  a  fourth  part  of  the  inhabitants  were  left 
alive.  In  London  alone  100,000  fell  victims  to  the  dis- 
ease, and  50,000  corpses  were  interred  in  one  burial- 
ground,  heaped  together,  layer  upon  layer,  in  large  pits. 
Throughout  Europe  it  has  been  estimated  that  twenty-five 
millions,  or  a  fourth  part  of  the  entire  population,  were 
swept  away.  Imagination  fails  to  realise  the  misery  and 
horrors  of  the  time.  The  sick  died  untended,  charity  was 
dead,  and  hope  extinguished — everywhere  there  was  terror 
and  black  despair. 

Without  noticing  other  epidemics  which  followed  the 
epoch  of  the  Black  Death,  the  next  great  pestilence  which 
ravaged  the  country,  and  known  as  the  Sweating  Sickness, 
broke  out  in  1485.  Unlike  the  Black  Death  and  the 
Oriental  Plague,  which  reappeared  in  the  sixteenth  and 
seventeenth  centuries,  it  did  not  originate  in  a  foreign 


PREVENTABLE  DISEASE.  7 

country  to  be  conveyed  by  infection  to  our  own  shores, 
but  it  sprang  into  existence  in  this,  and  was  no  doubt 
generated  and  propagated  by  the  insanitary  conditions  of 
dwellings  and  towns,  and  the  filthy  and  intemperate 
habits  of  the  people.  For  the  most  part  it  attacked 
robust  middle-aged  adults,  men  fond  of  good  living,  and 
those  amongst  the  poorer  classes  who  were  described  as 
"  idle  persons,  good  ale  drinkers,  and  tavern  haunters." 
Its  onset  was  quick  and  its  termination  rapid,  the  victim 
generally  dying  within  twenty-four  hours  ;  while  the  mor- 
tality was  so  great  that  in  many  parts  of  the  country  half 
of  the  male  adult  population  were  swept  away.  During 
the  latter  part  of  the  fifteenth  century,  and  the  first  half 
of  the  sixteenth,  this  pestilence  reappeared  no  less  than 
five  times,  its  last  visitation  having  occurred  in  1551. 
Yet  it  must  .not  be  forgotten  that  this  sixteenth  century, 
with  its  long  list  of  ravaging  diseases,  gave  us,  neverthe- 
less, the  heroes  of  the  Elizabethan  age,  our  triumph  over 
Spain,  and  our  English  Reformation.  But  progress  in 
sanitary  defence  was  slow,  tedious,  and  tentative.  Indeed, 
the  extraordinary  vitality  and  indomitable  pluck  of  the 
English  race  would  almost  appear  to  have  been  the  sole 
defences  against  national  decay  and  disaster,  for  during 
long  years  to  come  there  was  but  little  improvement  in 
the  homes  or  habits  of  the  people.  It  was  not  until  the 
Plague,  which  was  the  next  great  pestilence  after  the 
Sweating  Sickness,  had  repeatedly  devastated  the  country, 
and  the  great  fire  which  swept  away  the  crowded  and  filthy 
homes  of  London  in  1666  occurred,  that  people  began  to 
appreciate,  though  in  a  faint  and  glimmering  way,  the 
principles  of  prevention.  The  plague  died  out  with  the 
fire,  but  smallpox,  jail  fever,  malignant  sore  throat,  ague, 
scurvy,  and  other  controllable  diseases,  still  continued  to 
contribute  to  the  excessive  mortality  of  the  seventeenth 
century. 


8  PUBLIC  HEALTH  AND 

But  now  we  come  to  the  dawn  of  a  better  day.  The 
gradual  improvements  in  agriculture,  manufactures,  and 
commerce  were  adding  steadily  to  the  comforts  of  life. 
Food  was  becoming  more  plentiful,  and  the  diet  less 
coarse.  Vegetables,  and  more  especially  the  potato, 
were  becoming  much  more  generally  used ;  fresh  meat 
was  taking  the  place  of  salted  meat,  which  had  hitherto 
constituted  such  a  large  part  of  the  English  dietary ; 
while  tea  and  coffee  were  to  some  extent  replacing  the. 
strong  ale  and  ardent  spirits  which  had  formerly  proved 
such  a  baneful  source  of  disease.  People,  too,  were  be- 
ginning to  recognise  the  value  of  cleanliness  of  person  and 
home.  The  introduction  of  soap  and  soda  made  washing 
easier,  and  cotton  and  linen  articles  of  clothing  were 
gradually  coming  into  more  general  use.  Thus  far,  then, 
it  may  be  said  that  the  seventeenth  century,  although 
characterised  by  no  great  advance  in  sanitary  progress, 
witnessed,  nevertheless,  some  considerable  improvements 
of  an  incidental  and  indirect  kind.  The  gradual  emanci- 
pation from  the  thraldom  of  filth  had  begun,  and  pre- 
cautionary measures  against  the  spread  of  disease  in  the 
form  of  a  rough-and-ready  system  of  quarantine  were  here 
and  there  attempted.  But  the  great  purifier  of  the  cen- 
tury was  the  memorable  fire  of  London,  which  consumed 
everything  from  the  Tower  to  Temple  Bar,  destroying  81 
out  of  the  97  parishes  within  the  city  boundaries,  and 
two  of  the  parishes  outside  the  walls.  The  old  wooden 
houses  with  their  overhanging  stories,  and  the  huge  sign- 
boards swinging  across  the  narrow,  winding,  filthy,  unpaved 
streets,  were  swept  away  ;  and  though  the  model  city 
which  Sir  Christopher  Wren  had  planned  was  not  destined 
to  be  realised,  better  houses  were  constructed,  wider  streets 
laid  out,  and  sanitary  conditions  in  other  respects  were 
considerably  improved. 

Coming  now  to  the  health  history  of  the  eighteenth 


PREVENTABLE  DISEASE. 

century,  we  find  that  three  terrible  scourges,  namely,  the 
Black  Death,  the  Sweating  Sickness,  and  the  Plague,  have 
finally  disappeared  from  the  bills  of  mortality.  And  their 
disappearance,  as  we  have  seen,  is  not  to  be  attributed 
to  any  conscious  or  well-sustained  efforts  in  the  way  of 
prevention,  but  to  the  silent  influence  of  the  onward  pro- 
gress of  civilisation.  "We  now,  however,  enter  upon  an  era 
in  which  observation  and  induction  begin  to  play  a  part 
in  the  prevention  of  human  suffering,  when  the  physical 
causes  of  disease  receive  fuller  appreciation,  and  when  it 
is  at  last  recognised  that  these  causes  can  be  inquired  into 
and  dealt  with  in  a  scientific  manner.  It  is  true  that  the 
workers  were  few,  but  the  results  of  their  labours  have 
been  fraught  with  untold  blessings  to  humanity.  Fore- 
most amongst  these  pioneers  of  sanitary  science  we  find 
the  honoured  names  of  Captain  Cook,  John  Howard,  and 
the  immortal  Dr.  Jenner ;  and  now  let  us  glance  briefly 
at  the  good  work  which  they  accomplished. 

Captain  Cook's  name  is  associated  with  the  suppres- 
sion of  the  once  prevalent  disease — scurvy ;  a  disease 
which,  up  to  the  latter  half  of  the  eighteenth  century, 
decimated  our  armies  and  fleets,  and  often  proved  terribly 
fatal  amongst  the  civil  population.  It  is  a  disease  easily 
recognised  and  well  defined ;  fostered,  as  many  other 
diseases  are,  by  insanitary  conditions ;  but  its  real  cause 
is  a  diet  from  which  vegetables  and  fruits  have  been  ex- 
cluded, and  therefore  its  prevention  or  cure  depends  upon 
a  proper  supply  of  vegetable  food  or  vegetable  juices. 
It  is  true  that  all  this  had  been  known  or  surmised  long 
anterior  to  the  period  in  question ;  but  it  was  reserved 
for  Captain  Cook,  in  his  first  voyage  of  discovery  round 
the  world,  from  1772  to  1775,  to  prove  beyond  a  doubt 
that  the  disease  could  be  banished  from  every  ship's  crew, 
and  that  it  could  be  entirely  eradicated  on  land  and  sea. 
Hitherto  it  had  been  a  cause  of  great  mortality  amongst 


10  PUBLIC  HEALTH  AND 

seamen ;  and,  to  quote  •  one  instance  out  of  many,  in 
Anson's  famous  expedition  some  thirty  years  previous  to 
that  of  Captain  Cook,  out  of  a  total  number  of  9  0  0  hands 
600  died  before  the  expedition  returned,  and  chiefly  from 
scurvy.  During  Captain  Cook's  three  years'  voyage,  on 
the  other  hand,  there  were  only  four  deaths,  namely, 
three  from  accident  and  one  from  consumption,  out  of  a 
total  number  of  118  men.  Captain  Cook  thus  earned 
for  himself  a  foremost  place  amongst  the  sanitary  re- 
formers of  the  eighteenth  century ;  but  the  nation  took 
years  to  learn  the  lesson  which  he  taught,  and  many 
more  lives  had  to  be  sacrificed  before  it  became  compul- 
sory that  lime-juice  should  form  a  part  of  the  commis- 
sariat of  every  sea-going  vessel.  Scurvy,  too,  may  now 
be  reckoned  among  the  diseases  of  the  past,  although  it 
occasionally  reappears,  as  in  the  late  Arctic  expedition, 
but  only  through  blamable  neglect  or  some  other  mishap. 
The  next  great  reformer,  deserving  of  special  notice, 
was  the  great  and  good  John  Howard.  His  name,  as 
every  one  knows,  is  associated  with  the  prevention  of  a 
fatal  disease,  then  known  as  the  jail-fever,  which  was 
constantly  breaking  out  in  prisons  all  over  the  country, 
had  often  invaded  our  courts  of  law,  and  made  several 
assizes  memorable  as  the  Black  Assizes,  and  which  was 
continually  spreading  by  means  of  infection,  through  the 
agency  of  discharged  prisoners  and  debtors,  amongst  all 
classes  of  the  community.  The  disease  has  long  since 
been  recognised  to  be  the  same  as  typhus  fever,  and  John 
Howard  lived  the  life  of  an  apostle  and  died  a  martyr  in 
proving  that  it  is  a  disease  which  is  essentially  due  to 
filth  and  overcrowding.  Without  enlarging  on  the  inci- 
dents of  his  self-sacrificing  labours,  the  outcome  of  them 
is  simply  this — that  for  years  back  the  prisons  of  this 
country  have  been  proved  by  the  most  rigid  statistics  to 
be  far  healthier  than  our  homes,  and  that  so-called  pre- 


PREVENTABLE  DISEASE.  11 

rentable  disease  of  any  kind  is  of  such  rare  occurrence 
within  their  walls,  that  when  any  isolated  cases  do  appear 
they  at  once  give  rise  to  surprise,  and  are  sure  to  call 
for  inquiry. 

The  next  great  sanitary  triumph  of  the  eighteenth 
century  calling  for  special  notice  was  the  discovery  of 
vaccination.  That  most  hideous  and  terribly  fatal  disease, 
smallpox,  had  long  been  a  terror  and  scourge  to  all 
classes  of  the  community  here  and  abroad,  and  after  the 
disappearance  of  the  Plague  became  the  severest  epidemic 
of  the  country.  The  introduction  of  the  practice  of 
inoculation  at  the  instance  of  Lady  Mary  Wortley 
Montagu,  the  wife  of  the  English  Ambassador  at  Con- 
stantinople, which  took  place  somewhere  about  the  year 
1720,  while  it  modified  the  severity  of  the  disease, 
assisted  rather  than  otherwise  its  spread.  But  whether 
this  was  so  or  not,  we  find  from  the  bills  of  mortality  of 
the  time  that  during  the  ten  years  1771  to  1781  small- 
pox was  the  cause  of  100  out  of  every  1000  deaths  in 
London,  and  there  is  reason  to  believe  it  was  quite  as 
fatal  in  other  parts  of  the  country.  The  practice  of 
vaccination,  Jenner's  grand  discovery,  was  commenced  in 
the  year  1796,  and  although  it  was  several  years  after- 
wards before  it  became  general,  its  value  as  a  preventive 
measure  was  not  long  in  declaring  itself  in  a  steadily 
declining  mortality.  Thus,  according  to  well-authenticated 
returns,  while  the  mortality  was  88  per  1000  deaths  in 
the  last  ten  years  of  the  eighteenth  century,  it  has  fallen 
progressively  from  64  to  11  per  1000  deaths  during  the 
first  six  decades  of  the  present  century.  And  if  we  have 
still  recurrent  outbreaks  of  the  disease,  it  is  because  there 
are  thousands  of  people  living  at  the  present  day  who 
never  have  been  protected  by  vaccination,  and  many 
thousands  more  who  have  been  imperfectly  vaccinated. 
For  it  should  be  remembered  that  it  was  not  till  1840 


12  PUBLIC  HEALTH  AND 

that  we  had  any  vaccination  laws  at  all;  not  till  1853 
that  vaccination  was  provided  gratuitously  for  the  poor ; 
and  not  till  1867  that  vaccination  was  made  compulsory 
amongst  children  generally.  We  may  therefore  expect 
occasional  outbreaks,  though  of  constantly  decreasing 
severity,  for  years  to  come ;  but  that  the  disease  can  and 
will  be  finally  eradicated,  the  belief  is  as  deep-rooted  and 
strong  in  the  minds  of  medical  men  and  of  the  educated 
public  of  the  present  day  as  it  was  in  the  stout  brave 
heart  of  Edward  Jenner. 

In  addition  to  these  great  sanitary  triumphs  of  the 
eighteenth  century  there  were  others,  such  as  improve- 
ments in  ventilation  and  better  house  accommodation, 
which  were  also  contributing  their  share  in  lessening  the 
general  death-rate,  and  especially  in  the  reduction  of 
fevers  of  all  kinds.  Diseases  amongst  infants  and  young 
children  were  much  less  fatal  at  the  close  than  at  the 
beginning  of  the  century,  while  the  labours  of  John 
Howard  were  beginning  to  tell  on  the  home  habits  of  the 
people,  as  they  had  already  told  on  the  vast  improvement 
which  had  been  effected  in  the  sanitary  condition  of 
prisons  and  jails.  The  health  of  our  soldiers  and  sailors 
was  much  better  cared  for,  and  the  sickness  and  mortality 
greatly  reduced.  Altogether  the  progress  made  in  the 
actual  prevention  of  disease  was  very  considerable ;  and 
accordingly  we  find  from  the  bills  of  mortality  that  the 
death-rate  of  the  city  of  London,  which  in  the  seventeenth 
century  was  over  80  per  1000,  had  been  reduced  to  50 
per  1000,  and  for  some  years  back  it  has  averaged  only 
22  per  1000. 

Coming  now  to  the  beginning  of  the  present  century, 
we  find  the  country  engaged  in  that  long  fierce  struggle 
with  France  which  culminated  in  the  victory  of  Waterloo ; 
yet,  in  spite  of  the  constant  drain  in  men  and  money,  the 
population  kept  steadily  increasing  and  the  public  health 


PREVENTABLE  DISEASE.  13 

slowly  improving.  But  outside  London  there  were  no 
large  towns  teeming  with  overgrown  populations — none 
contained  so  many  as  100,000  inhabitants,  and  only  five 
exceeded  50,000.  By  and  by,  however,  there  came  a 
sudden  and  unprecedented  change  in  the  social  history  of 
the  country.  The  discovery  of  steam-power  opened  up 
new  sources  of  industry  of  almost  unlimited  extent  and 
variety.  Commerce  flourished  as  it  had  never  flourished 
before  ;  wealth  accumulated ;  work  became  plentiful ; 
living  became  easier ;  early  marriages  were  encouraged ; 
and  the  rapid  increase  of  population  begun  then  has 
continued  ever  since.  The  population  of  England  and 
Wales,  which,  in  round  numbers,  was  only  ten  millions 
in  1810,  had  increased  to  over  fifteen  millions  in  1838  ; 
and  at  the  present  day  it  amounts  to  over  twenty -six 
millions.  And  this  enormous  increase,  it  should  be  re- 
membered, has  taken  place  almost  exclusively  in  already 
populous  towns,  or  at  centres  of  industry  which  speedily 
became  populous.  But  under  what  conditions  ?  For  the 
most  part  in  the  dust  and  din  of  factories ;  the  vitiated 
air  of  mines  ;  the  stifling  atmosphere  of  workshops ;  the 
bustle  of  busy  warehouses ;  and  when  the  day's  work  was 
done,  in  overcrowded  houses  or  underground  cellars, 
heaped  together  in  filthy,  narrow,  and  unventilated  streets 
or  reeking  back  slums.  Even  in  the  construction  of  better 
class  houses  the  veriest  rudiments  of  sanitation  were  ne- 
glected, because  they  were  still  but  little  understood  and 
less  appreciated.  Instead  of  municipal  control  there  was 
general  apathy.  Sewers  had  to  be  constructed,  but  they 
were  of  the  worst  possible  description,  uneven,  leaky, 
unventilated,  and  incapable  of  being  flushed,  while  the 
house  drains  leading  into  them  were  quite  as  faulty  and 
imperfect.  Scavenging  was  neglected,  filth  accumulated 
everywhere,  cess-pits  multiplied,  and  wells  became  pol- 
luted. But  why  fill  up  the  disgusting  details  of  the 


14  PUBLIC  HEALTH  AND 

picture  ?  The  mischief  was  done,  and  in  spite  of  recent 
improvements  and  legislative  enactments,  it  will  take 
years  of  steady,  earnest,  sanitary  work,  and  millions  of 
money,  to  undo  it.  The  money,  no  doubt,  will  be  forth- 
coming, and  the  cleansing  of  the  Augean  stables  may  be 
accomplished  in  time ;  but  the  squalor,  the  misery,  the 
disease,  the  physical  deterioration,  and  the  moral  degrada- 
tion engendered,  have  imposed  a  load  of  vitiated  heritage 
which  will  tell  on  generations  yet  unborn,  and  which  at 
the  present  day  is  crushing  thousands  of  children  into  an 
early  grave. 

Meanwhile  the  Legislature  had  done  nothing,  or  next 
to  nothing,  to  mitigate  the  terrible  evils  which  were  fast 
accumulating.     With  the  exception  of  the  Factory  Act  of 
1833,  and  the  Poor  Law  Amendment  Act  of  the  following 
year,  no  public  measures  of  general  importance  had  been 
attempted,  and  even  these  were  haphazard  and  tentative. 
It  is  true  that  here  and  there  local  Acts  had  been  applied 
for  and  granted  by  Parliament  to  empower  town  authori- 
ties to  provide  water-supply  and  drainage,  but  it  was  not 
till  those  wonderful  series  of  returns  of  the  Kegistrar- 
General,  and  the  masterly  reports  of  the  late  lamented 
Dr.  Farr,  began  to   be  published,  that  public  attention 
became    thoroughly   aroused.      At    last,   thanks   to    the 
incessant   labours   of   Edward   Chad  wick,  Dr.   Farr,  Dr. 
Southwood  Smith,  Dr.  Guy,  and  other  pioneers  of  sani- 
tary  progress,  the   Health   of   Towns    Commission   was 
appointed,  and  their  first  report  appeared  in  1844, —  a 
report   in   which  the   relations   of  cause   and   effect,   as 
applied  to  disease,  were  made  so  glaring  and  manifest,  that 
among  the  intelligent  portions  of  the  community  there 
arose  a  loud  cry  for  legislative  interference.     Things  are 
still  bad  enough  in  the  present  day,  but  few  can  form  any 
adequate  conception  of  the  deplorable  sanitary  condition 
of  the  country  when  that  report  was  published.      From 


PREVENTABLE  DISEASE.  15 

every  large  town  to  which  the  long  list  of  queries  was  sent, 
there  came,  with  but  little  variation,  the  same  terrible  series 
of  replies — bad  drainage,  polluted  water,  unhealthy  houses, 
overcrowding,  filth  everywhere ;  and,  as  a  consequence,  an 
excessive  death-rate,  with  fever  and  filth-diseases  of  every 
description  adding  enormously  to  the  death-roll.      But  so 
powerful  were  vested  interests,  and  so  strong  the  opposi- 
tion to  interfere  with  the  liberty  of  the  subject  or  of  cor- 
porate bodies,  that  it  was  not  till  the  country  was  threat- 
ened with  a  second  visitation  of  cholera  as  severe  as  the 
epidemic  of  1831,  that  Parliament  became  alarmed  and 
passed  the  Public  Health  Act  of  1848.     Under  this  Act 
the  General  Board  of  Health  was  constituted,  with  a  staff 
of  inspectors  who  were  empowered  to  hold  public  inquiries 
and  report  on   the   sanitary  condition  of  towns  which, 
according  to  the  returns  of  the  Eegistrar- General,  showed 
an  excessive  rate  of  mortality.     The  Act  itself  was  event- 
ually adopted  or  enforced  in  a  great  many  towns  through- 
out the  country ;  but  as  it  was  of  a  permissive  nature,  like 
the  great  majority  of  the  sanitary  Acts  which  followed  it, 
the  beneficial  results  which  might  have  been  expected  to 
accrue  from  it  were  long  in  appearing,  and  were  by  no 
means  general.     Nevertheless,  it  originated  an  era  of  active 
sanitary  improvement  in  most  of  our  large  towns,  and  it 
merits  special  notice  as  the  first  outspoken  recognition  on 
the  part  of  the  Legislature  that  the  health  of  the  State 
concerns  the  statesman.     By  enabling  town  authorities  to 
borrow  money  and  spread  the  expense  of  public  works 
over  a  number  of  years,  it  removed   one  of  the  greatest 
obstacles  to  sanitation,  and,  as  a  consequence,  extensive 
schemes  of  sewerage  and  water-supply  were  soon  under- 
taken in  many  parts  of  the  country.     But,  unfortunately, 
the  engineers  of  those  days  largely  shared  the  general 
ignorance   of  sanitary   principles   which  then   prevailed. 
Sewers  were  badly  constructed,  insufficiently  ventilated, 


16  PUBLIC  HEALTH  AND 

and  unfiushed ;  many  of  them,  in  fact,  were  elongated  cess- 
pools, and  the  sewage  itself,  collected  at  one  or  more  out- 
falls, was  discharged  into  the  nearest  stream,  thereby 
creating  a  general  befoulment  of  our  rivers,  which,  in  spite 
of  numerous  injunctions,  became  so  serious  as  to  call  for 
a  special  Act,  which  was  passed  in  187G  under  the  title 
of  the  Kivers  Pollution  Act. 

Among  other  Acts  which  followed  the  Public  Health 
Act  of  1848  may  be  mentioned  the  Common  Lodging- 
Houses  Act  of  1851,  the  Labouring  Classes  Lodging- 
Houses  Act  of  the  following  year,  the  Metropolis  Manage- 
ment Act  of  1855,  and  the  Nuisances  Eemoval  Act  and 
the  Diseases  Prevention  Act,  both  of  the  same  year. 
But  during  the  interim  the  nation  had  been  learning 
another  terrible  lesson  in  sanitation.  The  horrors  of  the 
Crimean  war,  engendered  by  a  faulty  commissariat,  an 
utter  neglect  of  scavenging  and  cleanliness,  and  an  in- 
credible disregard  of  the  most  rudimentary  laws  of  health, 
at  last  aroused  and  excited  the  public  mind  to  the  point 
of  indignation,  and  so  in  1857  was  instituted  the  lloyal 
Commission  on  the  Health  of  the  Army.  Their  report, 
which  is  still  of  the  greatest  value,  was  soon  followed  by 
the  reports  of  the  Barrack  and  Hospital  Commission,  and 
of  the  Commission  on  the  Health  of  the  Army  in  India,  all 
of  which  demonstrated  in  the  most  complete  manner  that 
the  sick-rate  and  death-rate  of  the  army  were .  culpably 
excessive ;  while  the  adoption  of  their  recommendations, 
under  the  able  teaching  of  the  late  lamented  Dr.  Parkes, 
afforded  such  conclusive  proofs  of  the  grand  policy  of 
prevention,  that  a  stimulus  to  sanitary  reform  began  to 
permeate  the  more  intelligent  classes  among  the  general 
community  which  has  continued  to  increase  ever  since. 

The  powers  of  the  General  Board  of  Health  were 
transferred  by  Act  of  Parliament  to  the  Privy  Council  in 
1858,  and  in  the  same  year  the  Local  Government  Board 


PRKYKNTAttl.F.   MBIAJOL  1*7 

Act  was  passed,  which  consolidated  to  some  extent  the 
previous  Sanitary  Acts  which  were  in  force.  The  ap- 
pointment of  Mr.  Simon  as  medical  officer  to  the  Privy 
Council,  with  his  able  staff  of  medical  inspectors,  inaugu- 
rated a  new  era  in  civil  life.  The  material  causes  of 
disease  were  investigated  with  a  minuteness  and  com- 
pleteness of  detail  which  could  not  fail  to  influence  the 
most  sceptical,  and  the  series  of  reports  in  which  these 
investigations  are  embodied  and  commented  on  have 
become  the  classics  of  sanitary  literature.  To  any  one 
who  takes  the  trouble  to  read  these  reports,  it  becomes  at 
once  apparent  that  whatever  of  purely  beneficial  sanitary 
legislation  which  has  subsequently  come  into  force  has 
all  along  been  largely  indebted  to  Mr.  Simon's  foresight 
and  advocacy,  based  on  the  inquiries  of  such  able  co- 
adjutors as  Seaton,  Greenhow,  Buchanan,  Hunter,  Thorne, 
Netten  Kadcliffe,  Ballard,  and  others.  Many  of  these 
inquiries  will  be  specially  alluded  to  in  various  parts  of 
this  work,  but  this  brief  historical  sketch  would  be  incom- 
plete without  referring  to  two  discoveries  in  sanitary 
science  which  have  already  resulted  in  a  vast  amount  of 
good,  and  are  destined  to  be  of  still  greater  benefit  to  the 
nation.  I  allude  to  Dr.  Snow's  researches  with  regard  to 
the  etiology  of  cholera  (see  Chapter  VIII.)  and  the  differ- 
entiation between  typhus  and  typhoid  fever  as  regards 
causation  and  symptoms,  and  this  last  deserves  special 
notice. 

About  the  year  1848,  when  fever  was  plentiful 
enough  in  all  our  large  towns,  and  did  not  spare  country 
villages,  L)r.  Stewart,  so  well  known  for  his  contributions 
to  sanitary  literature,  Sir  William  Jenner,  and  a  few 
other  earnest  workers  in  hospital  wards,  began  to  observe 
that  among  the  numerous  cases  of  so-called  typhus  which 
came  under  their  care  there  were  many  which  presented 
symptoms  of  a  more  or  less  uniform  character,  but  differ- 

c 


18  PUBLIC  HEALTH  AND 

ing  in  many  respects  from  those  which  characterised 
typhus  fever.  These  symptoms  soon  came  to  be  recog- 
nised as  those  of  typhoid  or  enteric  fever,  and  subsequent 
inquiries  have  so  clearly  established  the  causes  and  mode 
of  propagation  of  the  fever  that  it  is  now  regarded  as  a 
disease  which  is  entirely  preventable,  and  one  which  we 
have  every  reason  to  believe  will  eventually  be  as  com- 
pletely banished  from  our  midst  as  the  ague,  which  was 
once  so  common  and  now  so  rare.  But  it  was  urged  by 
many,  when  this  disease  came  to  be  talked  about  and 
written  about,  and  was  frequently  found  to  be  due  to  the 
entrance  of  sewer-air  into  houses,  that  in  sewering  a  town 
public  authorities  only  increased  the  danger,  and  that  the 
money  expended  was  worse  than  wasted.  It  is  true 
that  there  was  some  show  of  foundation  for  this  belief, 
but  it  has  long  since  been  made  clear  that  any  outbreaks 
of  the  disease  which  have  been  traced  to  sewer  emana- 
tions were  due  not  to  the  system  itself,  but  to  faulty 
sanitary  engineering.  Indeed,  in  the  celebrated  report 
of  Dr.  Buchanan,  who  was  the  inspector  appointed  to 
visit  a  large  number  of  towns  and  make  special  inquiry 
into  this  subject,  there  was  no  point  more  clearly  estab- 
lished than  the  remarkable  reduction  which  had  taken 
place  in  almost  all  the  towns  where  a  system  of  sewer- 
age had  been  carried  out.  (See  Chap.  XIII.) 

Without  referring  to  other  important  inquiries,  such 
as  those  relating  to  unwholesome  trades  and  occupations, 
food -adulterations,  polluted  water-supply,  overcrowding 
and  unhealthy  house-accommodation,  milk-contamination, 
and  the  wide-spread  agency  of  filth  in  the  causation  of 
disease,  we  may  note  in  passing  the  principal  legislative 
measures  which  have  recently  been  enacted  to  cope  with 
these  evils.  And  among  these  may  be  mentioned  the 
Adulteration  of  Food  and  Drink  Act  of  1860  ;  Amend- 
ments of  the  Factory  Acts;  the  Sanitary  Act  of  1866  ; 


PREVENTABLE  DISEASK.  19 

the  Local  Government  Board  Act  of  1871,  which  vested 
in  one  central  hoard  the  powers  previously  exercised  hy 
the  Poor  Law  Board  and  the  Privy  Council ;  and  the 
Public  Health  Act  of  1872.  This  last  Act  divided  the 
country  into  urban  and  rural  sanitary  districts,  and  neces- 
sitated the  appointment  of  medical  officers  of  health  and 
sanitary  inspectors ;  while  the  Adulteration  of  Food  Act, 
which  was  passed  in  the  same  year,  authorised  the  ap- 
pointment of  public  analysts.  Then  followed  the  Public 
Health  Act  of  1875,  which  consolidated  the  previously 
existing  sanitary  Acts ;  and  in  the  same  year  were  passed 
an  amended  Adulteration  Bill,  and  the  Artisans'  and 
Labourers'  Dwellings  Act,  intended  to  sweep  away  the 
rookeries  in  our  large  towns.  The  Rivers  Pollution  Act 
followed  in  1876,  the  Canal  Boats  Act  in  1877,  and  the 
Public  Health  (Water)  Act  in  1878.  Reserving  the  con- 
sideration of  the  strictly  medical  aspects  of  these  various 
Acts  for  a  future  chapter  (see  Chapter  XVL),  it  may  be 
remarked  in  passing  that,  partly  owing  to  the  permissive 
nature  of  sanitary  legislation,  partly  to  the  conflicting 
opinions  and  want  of  harmony,  which  it  is  well  known 
have  hitherto  hampered  the  policy  of  the  Local  Govern- 
ment Board,  and  partly  to  the  supineness  of  Local  Authori- 
ties and  their  aversion  to  centralisation  and  Govern- 
mental interference,  sanitary  reform,  in  spite  of  all  the 
obligations  which  the  Legislature  has  imposed,  and  the 
measures  to  carry  them  out  which  it  has  provided,  remains, 
comparatively  speaking,  at  a  standstill  in  many  parts  of 
the  country.  It  is  true  that  in  many  other  localities  there 
is  abundant  evidence  of  sound  sanitary  progress,  but  so 
long  as  the  Public  Health  Service  is  allowed  to  continue 
in  its  present  chaotic  condition,  so  long  will  there  be  loop- 
holes for  the  evasion  of  duty  on  the  part  of  sanitary 
authorities,  and  inducements  to  remissness  on  the  part  of 
their  officers. 


20  PUBLIC  HEALTH  AND 

This,  however,  by  the  way.  Let  us  now  consider  for 
a  moment  the  vast  amount  of  preventable  disease  with 
which  sanitary  science  and  sanitary  legislation  had  to 
combat  at  the  date  of  the  passing  of  the  Public  Health 
Act,  1872.  It  was  then  estimated  by  Mr.  Simon  "  That 
the  deaths  which  occur  in  this  country  are  fully  a  third 
more  numerous  than  they  would  be  if  our  existing  know- 
ledge of  the  chief  causes  of  disease  were  reasonably  well 
applied  throughout  the  country ;  that  of  deaths,  which  in 
this  sense  may  be  called  preventable,  the  average  yearly 
number  in  England  and  Wales  is  about  120,000;  and 
that  of  the  120,000  cases  of  preventable  suffering  which 
thus  in  every  year  attain  their  final  place  in  the  death- 
register,  each  unit  represents  a  larger  or  smaller  group  of 
other  cases  in  which  preventable  disease,  not  ending  in 
death,  though  often  of  far-reaching  ill  effects  on  life,  has 
been  suffered.  And  while  these  vast  quantities  of  need- 
less animal  suffering,  if  regarded  merely  as  such,  would  be 
matter  for  indignant  human  protest,  it  further  has  to  be 
remembered,  as  of  legislative  concern,  that  the  physical 
strength  of  a  people  is  an  essential  and  main  factor  of 
national  prosperity;  that  disease,  so  far  as  it  affects  the 
workers  of  the  population,  is  in  direct  antagonism  to 
industry ;  and  that  disease  which  affects  the  growing  and 
reproductive  parts  of  a  population  must  also  in  part  be 
regarded  as  tending  to  deterioration  of  the  race. 

"  Then  there  is  the  fact  that  this  terrible  continuing 
tax  on  human  life  and  welfare  falls  with  immense  over- 
proportion  upon  the  most  helpless  classes  "of  the  com- 
munity ;  upon  the  poor,  the  ignorant,  the  subordinate,  the 
immature  ;  upon  classes  which,  in  great  part  through  want 
of  knowledge,  and  in  great  part  because  of  their  depend- 
ent position,  cannot  effectually  remonstrate  for  them- 
selves against  the  miseries  thus  brought  upon  them,  and 
have  in  this  circumstance  the  strongest  of  all  claims  on  a 


PREVENTABLE  DISEASI  .  21 

legislature  which  can  justly  measure,  and  can  abate,  their 
sufferings. 

"  There  are  also  some  indirect  relations  of  the  subject 
which  seem  to  me  scarcely  less  important  than  the  direct. 
For  where  that  grievous  excess  of  physical  suffering  is 
bred,  large  parts  of  the  same  soil  yield,  side  by  side  with 
it,  equal  evils  of  another  kind,  so  that  in  some  of  the 
largest  regions  of  insanitary  influence,  civilisation  and 
morals  suffer  almost  equally  with  health.  At  the  present 
time,  when  popular  education  (which  indeed  in  itself 
would  be  some  security  for  better  physical  conditions  of 
human  life)  has  its  importance  fully  recognised  by  the 
legislature,  it  may  be  opportune  to  remember  that, 
throughout  the  large  area  to  which  these  observations 
apply,  education  is  little  likely  to  penetrate,  unless  with 
amended  sanitary  law,  nor  human  life  to  be  morally 
raised  while  physically  it  is  so  degraded  and  squandered." 
(See  Thirteenth  Report  of  the  Medical  Officer  of  the  Privy 
Council.) . 

Or,  to  take  another  illustration.  According  to  the 
supplement  to  the  thirty-fifth  annual  report  of  the  Eegis- 
trar-General  published  in  1875,  there  are  fifty-four  large 
tracts  of  England  and  Wales  whose  annual  mortality- 
rate  is  only  17  per  1000,  less  by  five  than  the  average 
mortality-rate  of  the  whole  country,  less  by  ten  than  in 
nine  districts,  and  less  by  twenty-two  than  the  mortality 
reigning  for  ten  years  in  Liverpool.  It  therefore  appears 
that  there  are  influences  inimical  to  life  prevailing  to  a 
far  greater  extent  in  some  parts  of  the  country  than  in 
others,  and  a  closer  analysis  of  the  national  death-register 
demonstrates  still  more  clearly  that  this  excess  of  mor- 
tality is  for  the  most  part  due  to  diseases  which  in  other 
ways  are  known  to  be  preventable,  and  which  detailed 
mc-dk-al  inspections  in  various  localities,  at  the  instance  of 
the  Privy  Council  and  the  Local  Government  Board,  have 


22  PUBLIC  HEALTH  AND 

proved  to  be  dependent  upon  causes  which  are  not  only 
removable,  but  whose  very  existence  constitutes  an  offence 
against  sanitary  law.  These  causes  have  been  grouped  by 
Mr.  Simon  into  two  great  classes,  namely,  local  conditions 
of  filth  and  nuisance  polluting  air  and  water,  and  reckless 
disseminations  of  contagion ;  and  as  regards  both  these 
wide  fields  of  disease -causation,  the  various  enactments 
embodied  in  the  Consolidated  Health  Act  of  1875  have 
conferred  extensive  powers  upon  sanitary  authorities 
throughout  the  country  to  remove  the  former,  and  to  see 
that  protective  measures  and  penal  checks  are  fully  and 
fairly  carried  out  with  regard  to  the  latter. 

But  there  are  some  pessimists  who  have  maintained 
that  because  the  average  death-rate  of  the  country  has 
remained  stationary,  with  comparatively  slight  fluctuations, 
at  a  little  over  22  per  1000  from  1841  to  1870,  pre- 
ventive measures  and  the  vast  sums  which  have  been 
expended  on  sanitary  improvements  are  alike  powerless 
to  increase  the  mean  duration  of  life.  They  appear  to 
regard  the  average  age  at  death  which  prevailed  during 
that  period,  as  the  "  limit  which  nature  in  her  wisdom  " 
has  prescribed,  and  that  we  have  no  grounds  for  believing 
that  public  sanitation  will  ever  materially  lessen  the  per- 
sistently heavy  death-roll  of  the  nation.  But  such  an 
argument,  as  has  already  been  made  evident,  is  based  on 
inferences  which  a  closer  analysis  of  vital  statistics  proves 
to  be  altogether  untenable.  It  has  been  previously  shown, 
for  example,  that  the  death-rate  in  London  has  been 
lowered  from  8  0  per  1000  in  the  seventeenth  century,  to 
50  per  1000  during  the  past  century,  and  to  2 2 '4  per 
1000  in  the  decade  1871-80.  Then,  again,  we  find  that 
during  recent  years  the  death-rate  has  been  very  consider- 
ably lowered  in  many  other  towns  throughout  the  country, 
and  that  this  diminished  death-rate  has  admittedly  and 
unmistakably  been  brought  about  by  the  sanitary  improve- 


PKEVENTABLE  DISEASE. 


23 


ments  which  have  been  carried  out.  This  is  well  illus- 
trated by  the  following  table  given  in  the  Appendix  to 
Dr.  Kansome's  excellent  address  on  State  Medicine,  de- 
livered at  the  meeting  of  the  British  Medical  Association 
in  1877,  in  which  he  also  proves  that  in  these  and  other 
localities  where  new  schemes  of  water-supply  and  drainage 
had  been  completed,  there  has  been  a  marked  amelioration 
in  diseases  classed  as  preventable : — 

Districts  of  England  and  Wales,  showing  some  improvement  in  the 
Annual  Rate  of  Mortality  in  the  Three  Decades,  1841-50, 
1851-60,  1861-70. 


Enumer- 

Average Annual  Mortality. 

ated 

Name  of  District,  etc. 

Registration 
County. 

Popula- 
tion. 

Deaths  to  1000  living. 

1871. 

1841-50. 

1851-60. 

1861-70. 

North  Witchford  . 

Cambridge  . 

15,585 

27 

21 

20 

Whittlesey    . 
Wisbech 

Cambridge  . 
Cambridge  . 

7,002 
34,209 

25 
25 

23 
22 

21 
20 

Orsett  . 

Essex  . 

13,172 

24 

21 

18 

Salisbury 

Wilts  . 

9,212 

28 

24 

20 

Stoke  Damerel 

Devon 

49,449 

26 

23 

21 

Wolverhampton    . 

Stafford       . 

136,053 

27 

28 

24 

Coventry 

Warwick     . 

40,113 

27 

25 

21 

Macclesfield  . 

Chester 

59,339 

26 

25 

23 

Hull      . 

York  . 

68,316 

31 

25 

26 

Newport 
Merthyr  Tydtil      . 
Crickhowell  . 

Monmouth  . 
Glamorgan  . 
Brecknock  . 

61,252 
104,239 
20,147 

24 

28 
27 

22 
29 
25 

21 
25 
23 

It  is  no  doubt  true  that  these  reductions  have  been 
counterbalanced  by  increased  death-rates,  chiefly  in  the 
newer  towns  which  have  sprung  up  so  rapidly  in  mining 
and  manufacturing  districts;  but  considering  the  evils 
attendant  upon  overcrowding,  and  the  utter  neglect  of  all 
sanitary  principles  or  precautions,  it  may  be  fairly  argued 
that  even  a  stationary  average  death-rate  ought  to  be 
accepted  as  proof  of  progress.  Moreover,  it  should  be 
borne  in  mind  that  organised  sanitary  supervision  and 


24  PUBLIC  HEALTH  AND 

general  local  administration  do  not  date  further  back  than 
the   Public  Health  Act,   1872,  and   that   therefore  the 
results  have  not  yet  had  sufficient  time  todieclare  them- 
selves, because  the  evils  to  be  combated  were  so  enormous, 
and  the  supineness  to  encounter  them  is  in  many  parts 
of  the  country  still   so  apparent.     Notwithstanding  all 
this,  however,  it  is  satisfactory  to  note  that,  apart  from  a 
diminution  of  the  death-rate  in  particular  localities,  there 
has  been  a  real  and  sensible  decline  in  the  average  re- 
corded death-rate  of  England  and  Wales  during  the  past 
few  years.     Thus,  while  the  average  annual  death-rate 
during  the  thirty  years  1841-1870  was  22'37  per  1000, 
the  average  death-rate  during  the  period  1871-1875  was 
22,  while  during  the  five  years  1876-1880  it  had  fallen 
to  20 '8.     And  this  reduction  has  since  been  maintained, 
for,  according  to  the  last  quarterly  returns  of  the  Kegistrar- 
General  for  1882,  the  mean  death-rate  of  the  two  years 
1881-1882   was  19-3   per   1000,  being   2*1   below  the 
mean  rate  in  the  preceding  ten  years,  1871-80.     In  the 
words  of  the  Eegistrar-General,  this  implies  "  that  more 
than  100,000  persons  survived  the  last  two  years  whose 
deaths  would  have  been  recorded  had  the  average  rate  of 
mortality   in   the   preceding    decade    been    maintained." 
Coincident  with  a  reduction  of  the  general  death-rate  it  is 
also  satisfactory  to  find  from  the  same  returns  that  the 
mean  annual  death-rate  from  the  seven  principal  zymotic 
diseases,  which  had  been  3'87,  4'11,  and  3'36  per  1000 
respectively  in  the  three  decades  1851-60,  1861-70,1871- 
80,  did  not  exceed  2 '44  in  the  first  two  years  of  the  current 
decade ;  while   the   death-rate  from  fever  alone  did  not 
exceed  0*29  per  1000,  whereas  in  the  three  most  recent 
decades  it  was  equal  to  0'91,  0*89,  and  0*49  respectively. 
This  remarkable  reduction  in  the  death-rate  from  fever, 
mostly  enteric,  affords  the  strongest  possible  evidence  of 
the  beneficial  results  which  follow  in  the  wake  of  im- 
proved sanitation. 


PREVENTABLE  DISEASE.  25 

But  in  order  to  carry  on  this  combat  against  prevent- 
able disease  to  a  successful  issue,  we  want  a  thoroughly 
organised  P^lic  Health  Service,  with  efficiently  trained 
health  officers  who  shall  be  debarred  from  private  practice, 
and  competent  sanitary  inspectors,  all  of  them  holding 
permanent  appointments  under  the  control  of  the  Local 
Government  Board.  We  also  want  hospital  accommoda- 
tion within  easy  access  in  every  populous  district  for  the 
isolation  of  cases  of  infectious  disease,  and  compulsory  and 
early  information  of  all  such  cases,  and  we  want,  more- 
over, what  is  still  very  hard  to  get,  the  active  and 
intelligent  co-operation  of  the  people  themselves  in  im- 
proving and  maintaining  the  sanitary  condition  of  the 
home  and  its  surroundings.  Many,  too,  look  hopefully 
forward  to  the  vast  benefits  which  would  accrue  if  the 
relations  between  the  public  and  medical  profession,  to 
which  sanitary  science  owes  so  much,  were  entirely  altered. 
Hitherto,  the  public  generally  have  only  enlisted  the 
services  of  the  profession  when  disease  sets  in ;  but  it  is 
contended,  and  with  reason,  that  it  would  be  a  far  wiser 
policy  to  pay  the  medical  attendant  so  much  a  year,  and 
thereby  enlist  his  services  in  conserving  the  health  of  the 
household.  To  a  certain  extent  this  policy  is  already 
carried  out  in  club-practice  and  provident  dispensaries, 
but  there  would  be  no  difficulty  in  carrying  it  out  as 
regards  all  classes  of  the  community,  if  people  could  only 
be  persuaded  that  it  would  be  to  their  ultimate  advantage, 
while  the  rate  of  remuneration  to  be  paid  to  the  medical 
attendant  could  be  easily  arranged  on  a  fair  and  equitable 
basis.  For  it  need  hardly  be  said  that  so  long  as  medical 
men  are  paid  solely  and  simply  for  attempting  to  cure,  it 
is  obviously  not  to  their  interest  to  exercise  their  know- 
ledge and  skill  in  preventing  disease,  true  though  it  be 
that  the  efforts  of  the  profession  generally  are  seldom  lax 
in  controlling  those  diseases  which,  without  their  inter- 


26  PUBLIC  HEALTH  AND  PREVENTABLE  DISEASE. 

vention,  would  be  sure  to  spread.  Nor  should  it  be 
overlooked  that  there  is  a  long  list  of  other  diseases, 
appertaining  to  the  domain  of  domestic  hygiene,  such  as 
those  resulting  from  a  vitiated  heritage,  intemperance, 
errors  in  diet,  and  irregular  habits  or  modes  of  life,  which 
might  be  largely  controlled  if  the  services  of  the  medical 
practitioner  were  thus  enlisted  in  the  grand  policy  of 
prevention.  But,  unfortunately,  the  public  credulity  in 
the  power  of  cure  still  reigns  paramount,  while  their  faith 
in  prevention  lies  practically  dormant ;  and  hence  it  is 
that  quackery  of  every  description  continues  to  thrive, 
and  the  pills  and  potions  which  are  so  extensively  adver- 
tised find  a  ready  sale.  This,  however,  is  a  matter  in 
which  the  people  themselves  must  take  the  initiative,  and 
it  has  only  been  adverted  to  here  in  order  to  show  how 
curative  and  preventive  medicine  might  cordially  go  hand 
in  hand  for  the  promotion  of  the  public  health  and  the 
abatement  of  human  suffering. 


FOOD.  2  7 


CHAPTEK  II— FOOD. 

SECTION  I. — FUNCTIONS  AND  CONSTITUENTS  OF  FOOD. 

WITHOUT  entering  into  a  discussion  of  the  various  cheinico- 
physical  changes  which  food  undergoes  in  the  living  body, 
it  may  be  broadly  asserted  that  its  ultimate  destiny  is  the 
development  of  heat  and  other  modes  of  motion,  which 
together  constitute  the  physiological  phenomena  of  animal 
life.  The  potential  energy  with  which  the  food  is  stored 
becomes  converted  into  actual  or  dynamic  energy,  and  is 
manifested  in  the  body  as  heat,  constructive  power,  nervo- 
muscular  action,  mechanical  motion,  and  the  like.  But 
as  food  also  supplies  the  materials  which  are  requisite  for 
the  development  and  maintenance  of  the  living  fabric,  as 
well  as  for  the  display  of  its  various  kinds  of  active 
energy,  it  may  be  inferred  that  inorganic  and  organic 
substances  are  both  necessary.  The  organic  alone  are 
oxidisable,  or  capable  of  generating  force ;  while  the  jn_- 
organic,  though  not  oxidisable,  arejessential  to  the  meta- 
morphosis of  organic  matter  which  takes  place  in  the 
animal  economy. 

The  organic  constituents  of  food  are  generally  divided 
into  nitrogenous,  fatty,  and  saccharine  compounds ;  and 
the  inorganic  into  water  and  saline  matters.  Both  classes 
of  constituents  are  present  in  all  ordinary  articles  of  diet, 
whether  they  be  derived  from  the  animal  or  vegetable 
kingdom. 

1.   Functions  of  tlir  Nitrogenous    Constituents. — The 


26  PUBLIC  HEALTH  AND  PREVENTABLE  DISEASE. 

vention,  would  be  sure  to  spread.  Nor  should  it  be 
overlooked  that  there  is  a  long  list  of  other  diseases, 
appertaining  to  the  domain  of  domestic  hygiene,  such  as 
those  resulting  from  a  vitiated  heritage,  intemperance, 
errors  in  diet,  and  irregular  habits  or  modes  of  life,  which 
might  be  largely  controlled  if  the  services  of  the  medical 
practitioner  were  thus  enlisted  in  the  grand  policy  of 
prevention.  But,  unfortunately,  the  public  credulity  in 
the  power  of  cure  still  reigns  paramount,  while  their  faith 
in  prevention  lies  practically  dormant ;  and  hence  it  is 
that  quackery  of  every  description  continues  to  thrive, 
and  the  pills  and  potions  which  are  so  extensively  adver- 
tised find  a  ready  sale.  This,  however,  is  a  matter  in 
which  the  people  themselves  must  take  the  initiative,  and 
it  has  only  been  adverted  to  here  in  order  to  show  how 
curative  and  preventive  medicine  might  cordially  go  hand 
in  hand  for  the  promotion  of  the  public  health  and  the 
abatement  of  human  suffering. 


FOOD.  27 


CHAPTEE  II— FOOD. 

SECTION  I. — FUNCTIONS  AND  CONSTITUENTS  OF  FOOD. 

WITHOUT  entering  into  a  discussion  of  the  various  chemico- 
physical  changes  which  food  undergoes  in  the  living  body, 
it  may  be  broadly  asserted  that  its  ultimate  destiny  is  the 
development  of  heat  and  other  modes  of  motion,  which 
together  constitute  the  physiological  phenomena  of  animal 
life.  The  potential  energy  with  which  the  food  is  stored 
becomes  converted  into  actual  or  dynamic  energy,  and  is 
manifested  in  the  body  as  heat,  constructive  power,  nervo- 
rnuscular  action,  mechanical  motion,  and  the  like.  But 
as  food  also  supplies  the  materials  which  are  requisite  for 
the  development  and  maintenance  of  the  living  fabric,  as 
well  as  for  the  display  of  its  various  kinds  of  active 
energy,  it  may  be  inferred  that  inorganic  and  organic 
substances  are  both  necessary.  The  organic  alone  are 
oxidisable,  or  capable  of  generating  force ;  while  the  IQ- 
organic,  though  not  oxidisable,  are  essential  to  the  meta- 
morphosis of  organic  matter  which  takes  place  in  the 
animal  economy. 

The  organic  constituents  of  food  are  generally  divided 
into  nitrogenous,  fatty,  and  saccharine  compounds ;  and 
the  inorganic  into  water  and  saline  matters.  Both  classes 
of  constituents  are  present  in  all  ordinary  articles  of  diet, 
whether  they  be  derived  from  the  animal  or  vegetable 
kingdom. 

1.   Functions  of  the  Nitrogenous    Constituents. — The 


28       ^  FOOD. 

nitrogenous  constituents  consist  of  albumen  in  its  various 
forms,  fibrine,  syntonin  or  muscle-fibrine,  casein,  gluten, 
legumin,  and  other  allied  substances,  such  as  gelatine. 
Their  chemical  composition  is  remarkably  uniform,  and, 
as  they  seem  all  capable  of  being  reduced  by  the  digestive 
process  to  a  like  condition,  they  can  replace  each  other  in 
nutrition,  though  not  to  an  equal  extent. 

Up  to  a  comparatively  recent  period  it  was  believed 
that  nitrogenous  constituents  must  first  be  converted  into 
tissue  before  their  dynamical  energy  can  be  elicited ;  in 
other  words,  that  muscular  force  is  entirely  dependent  011 
the  metamorphosis  of  muscular  tissue,  and  that  urea, 
being  the  product  of  the  change,  ought  to  be  regarded  as 
a  measure  of  the  force.  This  was  the  doctrine  taught  by 
the  late  Professor  Liebig,  and  it  was  generally  accepted 
by  physiologists  until  Drs.  Tick  and  Wislicenus  of  Zurich 
published  their  famous  experiments  connected  with  their 
ascent  of  the  Faulhorn.  While  these  experiments  proved 
that  a  nonvnitrogenous  diet  will  sustain  the  body  during 
severe  exercise  for  a  short  period,  and  without  any  notable 
increase  in  the  amount  of  urea,  the  more  carefully  con- 
ducted experiments  subsequently  made  by  the  late  Dr. 
Parkes  showed  that  possibly  the  amount  of  urea  is  even 
lessened.  If  this  view  were  confirmed,  Dr.  Parkes'  infer- 
ence would  be  rendered  highly  probable — the  inference, 
namely,  that  muscle,  instead  of  oxidising  during  labour, 
and  becoming  wasted  by  losing  nitrogen,  does  in  reality 
appropriate  nitrogen,  and  grows,  and  that  its  exhaustion 
does  not  depend  so  much  on  decay  for  the  time  being,  as 
on  an  accumulation  of  the  oxidised  products  of  other  food 
constituents  within  its  tissues.  He  takes  care  to  point 
out,  however,  that  in  the  long  run  some  decay  of  muscle 
does  take  place,  and  that  the  amount  of  nitrogen  must  be 
increased  as  the  work  increases.  The  still  more  recent 
researches  of  Dr.  Pavey  in  the  case  of  Mr.  Weston,  so  well 


I  Li 
. 

y-   ^      ^JlC  ^fft^a^-  ?*      fat- 

FOOD.  29 

known  for  his  pedestrian  feats,  appear  to  indicate  that  at 
the  commencement  of  a  prolonged  muscular  effort,  the 
nitrogen  excreted  is  considerably  increased,  and  that  sub- 
sequently it  will  vary  pretty  much  according  to  the  amount 
contained  in  the  food  consumed  from  day  to  day. 

Judging  from  these  and  other  experiments,- it  would 
therefore  appear  that,  although  the  main  functions  of  the 
nitrogenous  constituents  of  food  are  the  construction  and 
repair  of  the  tissues,  they  exercise  other  important  func- 
tions of  a  regulative  and  dynamic  nature  not  well  defined. 
There  is  no  doubt  that  a.  certain  portion  of  them  is  directly 
decomposed  in  the  blood,  and  so  far  they  contribute  to 
the  maintenance  of  animal  heat  and  the  development  of 
dynamic  energy ;  but  the  experiments  of  Pettenkofer  and 
Voit  also  tend  to  show  that  the  nitrogenous  substances 
composing  the  tissues  determine  the  oxidation  of  the 
other  constituents,  or,  in  other  words,  that  no  manifesta- 
tion of  force  is  possible  without  their  participation  in  the 
process.  4t~^^c^  S-Qjuw***^  *fi  a£fa>^^  <*  /•$ 

2.  Functions  of  the  Fatty  Constituents. — The  fact  that 
food  containing  a  large  proportion  of  fatty  ingredients  is 
invariably  used  by  the  inhabitants  of  cold  countries,  indi-  ^ 
cates  that  these  constituents  play  an  important  part  in  the 
maintenance  of  animal  heat.  Indeed,  it  has  been  proved 
by  experiment  that  the  respiratory  or  heat -producing 
powers  of  fat  are  twice  and  a  half  as  great  as  those  of  the  ^ 
other  hydrocarbons,  as  starch  or  sugar.  Fat  also  takes  an 
active  share  in  the  conversion  of  food  into  tissue,  and  aids 
the  removal  of  effete  products  from  the  system.  The  experi- 
ments already  alluded  to  likewise  show  that  its  oxidation 
in  the  blood  generates  to  a  great  extent  the  force  which 
is  rendered  apparent  in  locomotion  or  manual  labour. 
Further,  its  distribution  in  the  tissues  gives  rotundity  to 
the  form,  serves  to  retain  animal  heat  by  its  non-conduct- 
ing properties,  and  greatly  facilitates  the  working  of  the 


32 


FOOD. 


GRS.  PER  POUND. 

GRS.  PER 

POUND. 

Carbon. 

Nitrogen. 

/-  A- 
Carbon. 

Nitrogen 

Split  peas 

2699 

248 

New  milk 

599 

44 

Indian  meal 

3016 

120 

Skim  cheese    . 

1947 

483 

Barley  meal 

2563 

68 

Cheddar  cheese 

3344 

306 

Rye  meal 

2693 

86 

Bullock's  liver 

934 

204 

Seconds  flour    . 

2700 

116 

Mutton    . 

1900 

189 

Oatmeal  . 

2831 

136 

Beef 

1854 

184 

Bakers'  bread  . 

1975 

88 

Fat  pork  . 

4113 

106 

Pearl  barley     . 

2660 

91 

Dry  bacon 

5987 

95 

Rice 

2732 

68 

Green  bacon     . 

5426 

76 

Potatoes  . 

769 

22 

White  fish 

871 

195 

Turnips  . 

263 

13 

Red  herrings   . 

1435 

217 

Green  Vegetables 

420 

14 

Dripping 

5456 

— 

Carrots    . 

508 

14 

Suet 

4710 

— 

Parsnips  . 

554 

12 

Lard 

4819 

— 

Sugar 

2955 

— 

Salt  butter 

4585 

— 

Treacle     . 

2395 

— 

Fresh  butter     . 

6456 

— 

Buttermilk 

387 

44 

Cocoa 

3934 

140 

Whey      . 

154 

13 

Beer  and  porter 

274 

1 

Skimmed  milk 

43S 

43 

As  this  table  contains  almost  all  the  articles  which 
are  likely  to  be  met  with  in  a  common  dietary,  it  becomes 
no  difficult  matter  to  calculate  the  total  amount  of  carbon 
and  nitrogen  which  any  such  dietary  yields,  and  to  com- 
pare the  results  with  other  dietaries  that  have  been  cal- 
culated in  the  same  way.  It  is  necessary  to  add  that  the 
nutritive  equivalents  apply  to  articles  in  their  uncooked 
state,  and  that  the  meat  is  boned. 


SECTION  III. — FOOD  AND  WORK. 

It  has  already  been  stated  that,  in  addition  to  main- 
taining the  body  in  a  healthy  state,  the  potential  energy 
of  food  is  the  sole  source  of  the  active  energy  displayed 
in  mechanical  motion  or  work.  It  therefore  follows  that 
the  diet  must  be  increased  as  the  work  increases  ;  and 
the  question  arises  at  the  outset,  What  is  the  minimum 


FOOD.  33 

amount  of  food  on  which  a  man  of  average  size  and 
weight  can  subsist  without  detriment  to  health  ?  From 
a  large  number  of  observations  made  by  Sir  Lyon  Play- 
fair  and  others  on  the  dietaries  of  prisons  and  workhouses, 
and  by  the  late  Dr.  Edward  Smith  on  the  amounts  of 
food  consumed  by  the  Lancashire  operatives  during  the 
cotton-famine,  it  would  appear,  according  to  Dr.  Letheby, 
that  a  barely  sustaining  diet  should  contain  about  3888 
grains  of  carbon  and  181  grains  of  nitrogen.  In  round 
numbers,  and  taking  a  somewhat  liberal  view  of  the 
•question,  Dr.  Edward  Smith  has  proposed  the  following 
averages,  as  representing  the  daily  diet  of  an  adult  man 
and  woman  during  periods  of  idleness  : — 

Carbon  (grains).  Nitrogen  (grains). 

Adult  man     .         .  4300  200 

Adult  woman          .  3900  180 

Average  adult      .         4100  190 

These  are  the  proportions  which,  according  to  Dr.  E. 
Smith's  researches,  are  actually  required  to  avert  starva- 
tion diseases ;  and  they  are  represented  in  the  case  of  a 
man's  diet  by  22  oz.  of  carbonaceous  food,  with  2'97  of 
nitrogenous. 

Taking  the  mean  of  all  the  researches  which  have 
been  made  by  eminent  physiologists,  Dr.  Letheby  has 
given  the  following  as  the  amounts  required  daily  by  an 
adult  man  for  idleness,  for  ordinary  labour,  and  for  active 
labour : — 


Daily  diets  for                         -nous.         Carl  numerous.  Carbon.  Nitrogen. 

Oxs.  (irs.            Ore. 

Idleness     .         .         2'67                    19'61\  i  3816         180 

Ordinary  labour         4  "56                    29 '24  I  =      -]  5688         307 

Active  labour    .         5 '81                    34 '97;  1 6823         391 


Very  often  the  standard  for  a  healthy  adult  employed  at 
ordinary  labour  is  stated  as  20  grammes  of  nitrogen,  and 

D 


34  FOOD. 

300  grammes  of  carbon,  equivalent  to  308*6  and  4629 
grains  respectively. 

And  here  it  may  be  observed  that  the  general  correct- 
ness of  these  averages  is  fully  borne  out  by  the  results  of 
the  numerous  experiments  which  have  been  made  to 
ascertain  the  amount  of  carbon  and  nitrogen  actually 
excreted  by  adult  men  under  different  conditions  of  diet 
and  exercise.  These  results  have  also  been  summarised 
by  Dr.  Letheby,  and  the  averages  are  found  to  correspond 
very  closely  with  those  just  given,  thus  :  — 

Daily  Requirements  of  the  Body  (LETHEBY). 


Food.        Carbon.  Nitrogen. 
Ozs.              Ozs.            Grs.  Grs. 

During  Idleness  \  By  dietaries   .         2'67          19*61  =  3816        180 

as  determined  J  By  excretions         278  21*60  =   4199         187 


Average       273  20 '60  =   4005         184 

Routine  work  as  \  By  dietaries  .         4 '56          29 '24  =  5688        307 
determined      J  By  excretions         4 '39          23*63  =  4694        296 

4-48          26-44        5191         302 

The  first  of  these  averages  is  represented  by  2  Ibs. 
2  oz.  of  bread ;  and  the  second  by  about  3-J-  Ibs.,  or  1  Ib. 
of  butcher  meat  with  about  4^  Ibs.  of  bread. 

The  actual  amounts  of  carbonaceous  and  nitrogenous 
matters  which  are  consumed  by  low-fed  and  well-fed 
operatives  are  given  in  the  following  tables : — 


FOOD. 


35 


<N 

T— I 

&  <N~  tC  oo"  t>T  ec    oT  c£  r-T  o    co    oo    <n 

NirHbbbbbbbbbbb         o 

J»o'o 
OrHOOOO<NCO»T5OJ<N        '  <X>  O 

p    <poposooooppppoop 

^ 

b 

rH 
P 

oo 

,  f \  rH  r^ 

|p  00  «0  <D  ^  <N  ^  <0  <P  00  ^  <»     oo 

OC$  <OlOCO-*«OOSJh-di<MOG^      00 


fiislliiili 

rSoS.»-)t!SSs>oS 


I 

2  2 


I  1 1  I f  I II I II 

*  *  £^S  f  S'T^'T^ 


-'**•*> 

~  ~  ~  ^ 

r/J  V2 


36  FOOD. 

Daily  Dietaries  of  Well-fed  Operatives  (PLAYFAIR). 


Starch 

Containing 

Containing 

Class  of  Labourer. 

Flesli- 
formers. 

Fats. 

and 

Sugar. 

Carbon- 
aceous. 

Nitro"- 
genous. 

/^ 
Carbon. 

N 

Nitro- 
gen. 

Ozs. 

Ozs. 

Ozs. 

Ozs. 

Ozs. 

Grs. 

Grs. 

Fully-fed  tailors    . 

4-61 

1-37 

18-47 

21-64 

4-61 

5136 

325 

Soldiers  in  peace  . 

4-22 

1-85 

18-69 

22-06 

4-22 

5246 

297 

Royal      Engineers 

(work)      .     .     . 

5-08 

2-91 

22-22 

29-38. 

5-08 

6494 

358 

Soldiers  in  war 

5-41 

2-41 

17-92 

23-48 

5-41 

5561 

381 

English  sailor  .     . 

5-00 

2-57 

14-39 

20-40 

5-00 

4834 

252 

French  sailor   .     . 

574 

1-32 

23-60 

2670 

574 

6379 

405 

Hard  -  worked 

weavers   .     .     . 

5-33 

1-53 

21-89 

25-42 

5-33 

6020 

375 

English  navvy 
(Crimea)  .     .     . 

573 

3-27 

13-21 

21-06 

5-73 

5014 

404 

English    navvy 
(Railway)      .     . 

6-84 

3-82 

27-81 

37-08 

6-84 

8295 

482 

Blacksmiths     .     . 

6-20 

2-50 

23-50 

29-50 

6-20 

6864 

437 

Prize-fighters 

(training)     .     . 

9-80 

3-10 

3-27 

1070 

9-80 

4366 

690 

Mean  of  all  .     . 

5-81 

2-42 

18-63 

24-31 

5-81 

5837 

400 

Mean  of  low-fed 

operatives 

3-04 

0-64 

21-18 

22-78 

3-04 

4881 

214 

As  an  addendum  to  these  data,  and  by  way  of  con- 
trast, I  may  here  give  some  particulars  with  reference  to 
the  dietaries  of  the  convicts  confined  in  English  prisons. 
In  the  hard-labour  prisons,  where  the  great  majority  of 
the  prisoners  are  employed  at  active  outdoor  work,  there 
are  two  scales  of  diet — viz.  the  light -labour  diet,  and 
the  full-labour  diet.  When  medical  officer  to  the  Ports- 
mouth Convict  Prison,  I  carefully  calculated  the  nutritive 
values  of  the  various  articles  of  food  contained  in  these 
diets,  according  to  the  equivalents  given  in  a  preceding 
table,  and  the  results  were  as  follows  : — 


DAILY  AVERAGE. 


Light-labour  diet 
Full-labour  diet 


Carbon,  Grs.     Nitrogen,  Grs. 
4651  224 

5289  255 


FOOD.  37 

What  is  called  light  labour  applies  to  manual  work 
requiring  very  little  muscular  exertion,  while  full  labour 
embraces  a  variety  of  occupations,  such  as  tailoring,  shoe- 
making,  artisan  work,  and  navvy  work.  From  the  aver- 
ages already  given,  it  will  be  inferred  that  the  light-labour 
diet  was  quite  sufficient  for  the  easy  nature  of  the  work, 
and,  practically,  with  few  exceptions,  this  was  found  to 
be  the  case.  The  prisoners  employed  at  light  labour 
were  all  more  or  less  invalid  or  crippled,  and  although 
almost  all  of  them  could  have  taken  more  food,  they  were 
not  found  to  lose  weight,  except  in  isolated  cases.  With 
regard  to  the  practical  working  of  the  full-labour  diet, 
however,  this  much  could  not  be  said  ;  for  while  prisoners 
employed  at  comparatively  easy  labour,  such  as  artisan 
work,  did  not  lose  weight  to  any  extent,  those  employed 
at  the  more  arduous  kinds  of  labour,  such  as  navvy  work, 
almost  invariably  lost  a  great  deal,  and  after  a  time  had 
In  be  removed  to  lighter  work  to  recruit.  In  whole  gangs 
of  prisoners  employed  at  filling  and  wheeling  barrows  of 
clay,  for  example,  I  found  an  average  loss  of  weight  of 
over  1 3  Ibs.  per  prisoner,  the  loss  accruing  within  a  period 
of  about  two  months  after  they  had  been  put  to  such 
work.  The  consequence  was  that  the  convicts  had  to  be 
continuously  shifted  from  hard  to  lighter  work,  and,  after 
recruiting,  from  lighter  to  hard,  otherwise  they  would  have 
completely  broken  down,  on  account  of  the  insufficiency 
of  the  full -labour  diet  for  the  severer  kinds  of  prison 
labour.  In  military  prisons,  according  to  Dr.  Letheby, 
where  the  dietary  contains  as  much  as  5090  grains  of 
carbon  and  256  grains  of  nitrogen  daily,  even  for  short 
periods  of  confinement,  many  of  the  prisoners  lose  weight, 
and  give  evidence  of  other  signs  of  decay,  so  that  it  is 
found  necessary  to  increase  the  diet  for  longer  periods  to 
62  Drains  of  carbon  and  317  of  nitrogen.  Of  course 
military  prisoners  require  more  food  than  convicts,  hide- 


38  FOOD. 

pendently  of  the  nature  of  the  work  at  which  they  may 
be  employed,  inasmuch  as  they  are  larger  men,  and  the 
ordinary  physiological  wants  of  the  body  demand  a  pro- 
portionately greater  amount  of  nutriment.  But  the  differ- 
ence in  stature  between  the  two  classes  of  prisoners  does 
not  account  for  such  a  difference  in  diets,  and  I  have  no 
doubt  that  convicts  employed  at  active  outdoor  labour 
would  require  at  least  as  much  as  is  represented  by  the 
average  diet  for  ordinary  labour  given  by  Dr.  Letheby — 
viz.  a  diet  containing  5688  grains  of  carbon  and  307 
grains  of  nitrogen  daily,  to  maintain  them  in  good  health, 
and  prevent  serious  loss  of  weight. 


SECTION  IV. — CONSTRUCTION  OF  DIETARIES. 

By  reference  to  the  numerous  data  already  given,  it 
will  not  only  be  easy  to  calculate  the  nutritive  value  of 
any  given  dietary,  but  a  reliable  opinion  may  be  formed 
as  to  its  suitability  as  well  as  sufficiency  under  specified 
circumstances.  It  now  remains  to  point  out  the  more 
important  principles  which  ought  always  to  be  kept  in 
view  in  the  construction  of  dietaries  ;  and,  apart  from  the 
influence  of  work,  which  has  already  been  considered,  they 
may  be  briefly  summarised  as  follows : — 

1.  Influence  of  Sex. — In  the  case  of  in -door  opera- 
tives, the  dietaries  of  women  should  be  about  one-tenth 
less  than  those  of  men. 

2.  Influence  of  Age. — Up  to  nine  years  of  age  a  child 
should  be  dieted-  chiefly  on  milk   and  farinaceous  sub- 
stances.    At  ten  years  of  age  it  will  require  half  as  much 
nutriment  as  a  woman ;  and  at  fourteen  quite  as  much 
as  a  woman.     Young  men  who  have  not  reached  their 
full  growth,  but  who  are  doing  the  same  amount  of  work 
as  adult  men,  require  more  food  than  the  latter. 


FOOD.  39 

3.  Selection   of  Food. — This   embraces  a   variety   of 
considerations,  such  as — 

(1.)  The  relative  proportions  of  proximate  constituents. 
—These  have  already  been  shown  in  Moleschott's  num- 
bers, and  they  correspond  very  closely  with  those  given 
by  Dr.  Letheby — viz.  22  of  nitrogenous  substances,  9  of 
fat,  and  69  of  starch  and  sugar.  "Whether  the  diet  be 
mixed  or  purely  vegetable  the  same  proportions  hold 
good,  and  the  results  of  experience  prove  that  they  are 
substantially  correct.  For  example,  articles  of  food  which 
are  deficient  in  one  class  of  constituents  are  invariably 
associated  with  others  which  contain  an  excess  of  them. 
Thus  we  have  butter,  or  milk,  or  cheese,  with  bread ; 
bacon  with  veal,  liver,  and  fowl ;  melted  butter  or  oil 
with  fish,  and  so  on.  Such  combinations  are  also  of 
great  service  in  aiding  the  digestibility  of  food.  For 
reasons  to  be  afterwards  stated,  every  dietary  should  con- 
tain fresh  vegetables. 

(2.)  Variety  of  Food. — But  even  when  the  proper 
proportions  of  constituents  are  provided  for  in  a  dietary, 
it  is  further  necessary  that  certain  articles  belonging  to 
the  same  class  be  varied  from  day  to  day,  otherwise  the 
appetite  cloys.  Beef  should  alternate  with  mutton,  for 
example ;  or  variety  may  be  secured  by  different  modes 
of  cooking  the  same  article.  Indeed,  it  is  not  too  much 
to  say  that  the  art  of  cookery  is  a  matter  of  national  im- 
portance, not  only  because  it  renders  food  palatable,  but 
because  the  more  it  is  studied  and  practised  the  greater 
is  the  economy  which  may  be  effected.  It  is  chiefly  in 
this  respect  that  beverages,  condiments,  etc.,  become  such 
valuable  dietetic  adjuncts. 

It  may  here  be  noted  that,  in  apportioning  rations  of 
meat,  20  per  cent  must  be  allowed  for  bone.  The  loss  in 
weight  by  cooking  varies  from  20  to  30  per  cent. 


40  FOOD. 

(3.)  Digestibility.  —  This  also  in  great  measure  de- 
pends upon  the  mode  of  cooking. 

(4.)  Price.  —  For  much  practical  information  on  this 
and  other  points,  see  Dr.  Edward  Smith's  Practical  Dietary, 
or  his  report  on  the  Food  of  the  Lancashire  Operatives, 
in  the  Fifth  Eeport  of  the  Medical  Officer  to  the  Privy 
Council. 

4.  Number  and  Distribution  of  Meals.  —  Experience 
teaches  that  three  meals  daily  are  best  suited  to  the  wants 
of  the  body.  Dr.  Edward  Smith,  in  his  physiological  diet 
of  4300  grains  of  carbon  and  200  of  nitrogen,  distributes 
the  amounts  as  follows:  — 


Carbon.  Nitrogen. 

grs.  grs.  oz.  oz. 

For  Breakfast        .         .         .    1500          70     =  6  '62  1'04 

For  Dinner  .         .         .         .    1800          90     =  7  '85  1'34 

For  Supper   ....    1000  40     =  4  "52  0'59 


Total  daily         .         .         .    4300        200  18'99  2'97 

5.  Climate. — Other  things  being  equal,  carbonaceous 
substances  ought  to  contain  a  preponderance  of  fatty 
constituents  in  cold  climates,  and  of  starchy  or  farina- 
ceous in  warm  climates.  This  also  applies  to  seasonal 
variations. 

SECTION  V. — PRESERVED  FOODS. 

Only  a  few  of  these  need  be  mentioned. 

1.  Extractum  Carnis. — Liebig's  extract  is  perhaps  the 
best  known,  but  there  are  several  other  extracts  in  the 
market  of  almost  identical  composition.  According  to 
Dr.  Parkes,  Liebig's  extract  is  very  restorative,  removing 
all  sense  of  fatigue  after  great  exertion.  Its  nutritive 
qualities  are  inferior  to  those  of  ordinary  beef-tea,  but  it 
can  often  be  taken  by  an  invalid  when  beef-tea  would  be 
rejected  ;  and  it  has  the  further  advantage  of  being  readily 
prepared. 


FOOD.  41 

2.  Preserve*/    M>»t.  —  Weight    for   weight,  preserved 
meat  is  not  so  nutritious  as  properly  cooked  fresh  meat, 
because  the  process  of  preservation  requires  that  it  should 
be  over-cooked.     The  great  difference  in  price,  however, 
more  than  compensates  for  this  slight  disadvantage,  and 
on  the  score  of  economy  alone  it  deserves  to  be  exten- 
sively used.     Large  quantities  of  it  are  now  consumed  in 
workhouses  and  asylums.     It  is  best  used  cold,  or  warmed 
and  mixed  with  potatoes  and  vegetables  to  form  a  stew ; 
or  it  may  be  minced   and  warmed.     In  Dr.  Williams' 
experiments  in  the   Sussex  County  Asylum,  the  patients 
were  allowed  amounts  equal  to  the  uncooked  fresh  meat 
daily  ration,  with  the  result  of  a  slight  gain  in  weight  in 
13  of  the  20  experimented  on  at  the  end  of  a  month, 
the  weight  of  the  others  remaining  stationary. 

Soups  of  various  kinds,  fish,  poultry,  game,  are  now 
sold  in  large  quantities  as  preserved  foods,  while  fresh 
meat  is  largely  imported  from  Australia  and  America  in 
refrigerating  chambers. 

3.  Preserved  Vegetables. — When  fresh  vegetables  can- 
not be  procured  in  sufficient  quantity,  dried  vegetables 
should  be  employed  to  make  up  the  deficiency.     In  lieu 
of  potatoes  in  the  early  part  of  summer,  preserved  potatoes 
may  be  used ;  but  as  they  are  apt  to  pall  on  the  appetite, 
other   substitutes,  such  as  a  mess  of  rice  and  cabbage, 
pease-pudding,  or  haricot  beans,  should  be  given  on  alter- 
nate days. 

4.  /  ••/  Milk. — Condensed  milk   as  usually  pre- 
pared consists  of  pure  milk  sweetened  with  a  little  sugar. 
As  one  volume  of  the  condensed  milk  contains  the  nutri- 
tive material  of  four  volumes  of  fresh  milk,  it  should  be 
diluted  with  three  times  its  volume  of  water  when  used. 


42  FOOD. 

SECTION  VI. — EXAMINATION  OF  FOOD. 

It  need  scarcely  be  said  at  the  outset  that  a  thorough 
practical  knowledge  of  the  qualities  and  appearances  pre- 
sented by  the  various  articles  of  diet,  in  their  wholesome 
or  unadulterated  state,  is  a  necessary  qualification  for  the 
detection  of  unwholesome  or  adulterated  specimens. 

1.  Meat.  —  The  characters  of  good  meat  may  be 
enumerated  as  follows  : — 

(1.)  On  section  it  should  present  a  marbled  appear- 
ance from  intermixture  of  streaks  of  fat  with  muscle. 
This  shows  that  the  animal  has  been  well  fed. 

(2.)  The  colour  of  the  muscle  should  neither  be  too 
pale  nor  too  dark.  If  pale  and  moist,  it  indicates  that 
the  animal  was  young  or  diseased ;  and  if  dark  or  livid, 
it  shows  that  in  all  probability  the  animal  was  not 
slaughtered,  but  died  with  the  blood  in  it. 

(3.)  Both  muscle  and  fat  should  be  firm  to  the  touch, 
not  moist  or  sodden,  and  the  latter  should  be  free  from 
hsemorrhagic  points. 

(4.)  Any  juice  exuding  from  the  meat  should  be 
small  in  quantity,  be  of  a  reddish  tint,  and  give  a  dis- 
tinctly acid  reaction  to  test-paper.  Good  meat  should 
dry  on  the  surface  after  standing  a  day  or  two.  The 
juice  of  bad  meat  is  alkaline  or  neutral. 

(5.)  The  muscular  fasciculi  should  not  be  large  and 
coarse,  nor  should  there  be  any  mucilaginous  or  purulent- 
looking  fluid  to  be  detected  in  the  intermuscular  cellular 
tissue. 

(6.)  The  odour  should  be  slight,  and  not  by  any 
means  disagreeable.  An  unpleasant  odour  indicates  com- 
mencing putrefactive  change,  or  that  the  meat  is  diseased. 
By  chopping  a  portion  of  the  meat  into  small  pieces,  and 
afterwards  drenching  it  with  warm  water,  any  unpleasant- 
ness of  odour  will  be  more  readily  detected.  Another 


FOOD.  43 

good  plan  is  to  thrust  a  long  clean  knife  into  the  flesh, 
and  smell  it  after  withdrawal. 

When  the  meat  is  wasted,  pale,  flabby,  and  watery, 
it  indicates  that  the  animal  has  been  suffering  from  some 
wasting  disease,  such  as  consumption  or  rot.  The  ribs 
should  always  be  examined  for  pleuritic  adhesions,  the 
brain  and  liver  for  hydatids,  and  the  lungs  for  multiple 
abscesses.  But  it  is  seldom  that  the  butcher  who  wishes 
to  sell  diseased  meat  leaves  any  of  the  organs  or  offal 
exposed  to  the  risk  of  detection.  As  a  rule,  they  are  all 
most  carefully  concealed  or  destroyed,  and  various  strata- 
gems, such  as  smearing  the  carcase  with  melted  fat,  are 
adopted  to  improve  the  appearance  of  the  meat. 

If  parasitic  disease  is  suspected,  the  muscular  fibre 
should  be  examined  under  the  microscope.  Cysticerci, 
though  generally  visible  to  the  naked  eye,4  can  only  be 
accurately  detected  under  a  low  power,  and  the  booklets 
should  always  be  seen.  In  searching  for  trichina,  it 
should  be  remembered  that  the  parts  most  likely  to  be 
infected  are  the  diaphragm,  the  intercostal  muscles,  and 
the  muscles  of  the  jaw.  A  low  power  of  50  to  100 
diameters  will  be  found  to  be  sufficient. 

The  most  common  diseases  which  render  the  flesh  of 
animals  unfit  for  human  food  are — pleuro-pneumonia ; 
phthisis,  leading  to  extreme  wasting ;  rinderpest,  or 
cattle -plague;  anthrax,  or  malignant  pustule;  splenic 
apoplexy  or  Iraxy  in  sheep ;  foot-and-mouth  disease  in 
its  last  stages ;  rot  or  the  fluke  disease  in  sheep ;  pig- 
typhoid;  pig -measles  in  the  advanced  stage;  puerperal 
fever  or  dropping  after  calving;  and  acute  febrile  dis- 
orders from  whatever  cause. 

In  1880  a  very  warm  discussion  was  aroused  in  con- 
sequence of  the  Metropolitan  Board  of  Works  sanctioning 
the  sale  of  the  flesh  of  animals  slaughtered  for  pleuro- 
pneumonia  as  fit  for  human  food,  and  though  no  doubt 


44  FOOD. 

meat  of  this  description  has  been  eaten  in  large  quantities 
with  apparent  immunity,  it  was  urged  that  in  adopting 
such  a  course  more  respect  was  paid  to  the  views  of 
veterinary  surgeons  than  of  medical  men.  But  so  far  as 
the  duties  of  medical  officers  of  health  are  concerned,  it 
will  generally  be  found  that,  no  matter  whether  the  meat 
is  much  diseased  or  not,  it  is  exposed  for  sale  as  sound 
meat,  and  as  it  is  thus  palmed  off  on  the  public  under  a 
fictitious  character,  there  ought  to  be  no  hesitation  in 
condemning  it.  Very  often  the  defence  is  set  up  that 
the  meat  is  intended  for  dog's  meat;  but  if  evidence  is 
forthcoming  that  the  meat  has  been  dressed  in  the  usual 
way,  there  is  generally  very  little  difficulty  in  obtaining 
a  conviction.  In  cases  of  suspected  dropping  after  calv- 
ing, the  udders  and  peritoneal  lining  should  be  carefully 
examined,  while  in  all  cases  the  flanks  should  be  looked 
to,  because  it  is  often  in  these  parts  that  putrefactive 
change  first  sets  it.  As  regards  rules  for  seizure  and 
legal  proceedings,  see  Chapter  XVI. 

Bad  meat  is  usually  sodden  and  flabby,  with  the  fat 
dirty  or  gelatinous-looking,  and  the  smell  unpleasant  or 
sickly. 

I  may  here  mention  that  it  is  the  practice  in  the  City 
of  London  to  condemn  the  flesh  of  all  animals  infected 
with  parasitic  disease,  such  as  measles,  flukes,  etc.;  of 
animals  that  may  have  been  suffering  from  acute,  febrile, 
or  wasting  diseases ;  and  of  those  which  have  died  from 
natural  causes  or  by  accident ;  as  well  as  all  meat  tainted 
by  physic,  or  in  a  high  state  of  putrefaction.  It  is  also 
the  practice  to  condemn  the  flesh  of  any  animal  which 
has  been  killed  immediately  before,  during,  or  immedi- 
ately after  parturition,  on  the  presumable  grounds  that 
an  animal  would  not  be  slaughtered  under  such  circum- 
stances unless,  from  some  cause  or  other,  death  appeared 
to  be  impending. 


FOOD.  45 

Bad -smell  ing  sausages,  or  sausages  which  have  a 
nauseous  or  putrid  taste,  a  very  acid  reaction,  or  a  soft 
consistence  in  the  interior,  are  highly  dangerous,  and 
should  always  be  condemned.  So  too  with  fish  which 
has  become  sodden  or  discoloured,  and  gives  off  an  offen- 
sive or  arnmoniacal  odour. 

2.  Flour. — What  is  called  good  household  flour  or 
"  seconds  "  should  contain  very  little  bran,  be  quite  white, 
or  only  slightly  tinged  with  yellow,  and  should  give  no 
acidity  or  musty  flavour  to  the  taste.     It  should  not  be 
lumpy  or  gritty  to  the  touch,  nor  should  it  yield  any 
odour  of  mouldiness  to  the  sense  of  smell.     When  made 
into  a  paste  with  a   little  water,  the  dough  should  be 
coherent  and  stringy. 

The  amount  of  gluten  can  be  ascertained  by  washing 
carefully  a  known  quantity  of  flour,  made  first  into  a 
rather  stiff  dough,  until  the  water  comes  off  quite  clear. 
The  gluten,  when  baked  or  dried,  should  be  clean-looking, 
and  should  weigh  at  least  8  per  cent  of  the  quantity  of 
flour  taken  for  examination.  A  good  flour  will  yield  10 
to  12  per  cent.  Bad  flour  gives  a  dirty -looking  gluten, 
which  is  deficient  in  cohesion,  and  cannot  be  drawn  out 
into  long  threads. 

Flour  is  sometimes  adulterated  with  barley -meal, 
maize,  rice,  potato -starch,  etc.  Samples  of  doubtful 
quality  should  therefore  be  examined  microscopically. 
Fungi,  vibriones,  and  the  Acarus  farince,  are  detected  in 
flour  which  is  undergoing  putrefactive  change. 

3.  Bread. — The  crust  should  be  well  baked,  not  burnt. 
The  crumb  should  not  be  flaky  or  sodden,  but  ^regularly 
permeated   with   small   cavities.       The   taste   and   smell 
should  both  be  agreeable,  and  free  from  acidity.     Unless 
there  is  a  considerable  quantity  of  bran  in  the  flour,  the 
colour  should  be  white,  not  dark  or  dirty-looking. 

Good  flour,  well  baked,  yields  about  136  Ibs.  of  bread 


46  FOOD. 

per  100  Ibs.  of  flour,  and  adulteration  is  chiefly  directed 
to  increase  this  ratio  by  making  the  gluten  hard,  and  the 
bread  more  retentive  of  water.  This  the  dishonest  trades- 
man effects  by  adding  alum,  copper  sulphate,  or  a  gummy 
mixture  of  ground  rice.  The  bread  may  be  recognised 
by  its  becoming  sodden  and  doughy  at  the  base  after 
standing  for  some  time. 

4.  Oatmeal.  —  Good    oatmeal    is    generally    roughly 
ground,  and  contains  a  fair  proportion  of  envelope  freed 
from  the  husks.     If  husks  are  present,  the  probability  is 
that  the  meal  has   been   adulterated  with  barley.     The 
starch  should  not  be  discoloured,  and  the  meal  itself  should 
be  agreeable  to  the  palate.     If  the  meal  looks  suspicious, 
it  should  be  examined  microscopically. 

5.  Milk. — Pure  cow's  milk,  when  placed  in  a  tall 
narrow  glass  vessel,  should  be  perfectly  opaque,  of  a  full 
white  colour,  free  from  deposit,  and  should  yield  from 
6  to  12  per  cent  of  cream  by  volume.     When  boiled  it 
should  not  change  in  appearance,  and  when  allowed  to 
stand  for  some  time  there  should  be  no  deposit.     As  it 
is  frequently  adulterated  with  water,  the  specific  gravity 
is  an  approximate  test  of  the  quality,  and  hence  the  use 
of  the  lactometer.     The  specific  gravity  varies  from  1026 
to  1035;  if  it  falls  below  1026  it  shows  that  the  milk 
is.  either  very  poor,  or  that  a  certain   amount  of  water 
has  been  added.     The  following  table  by  Dr.  Letheby 
indicates  approximately  the  amount  of  water  adultera- 
tion according  to  the  specific  gravity  and  percentage  of 
cream : — 

Specific         Percentage      Specific  Gravity 
Gravity,   volume  of  cream,  when  skimmed. 

Genuine  milk    .  .  ,    .    .  1030  12'0  1032 

Do.    with  10  per  cent  water  1027  10 '5  1029 

Do.     ,,  20   „    „  1024  8-5  1026 

Do.     ,,  30   ,,    „  1021  6-0  1023 

Do.     „  40   „    ,,  1018  5-0  1019 

Do.        50  1015  4-5  1016 


FOOD.  47 

"When  milk  is  largely  adulterated  with  water,  other 
substances,  such  as  treacle,  salt,  and  turmeric,  are  some- 
times added  to  improve  the  flavour  and  appearance ;  but, 
generally  speaking,  the  use  of  a  graduated  glass  vessel  to 
determine  the  percentage  of  cream,  and  testing  the  specific 
gravity,  will  enable  one  to  give  a  reliable  opinion  as  to 
whether  the  milk  is  genuine  or  not.  Suspicious  samples 
should  be  sent  to  the  public  analyst  for  analysis. 

Milk  from  diseased  animals,  or  from  animals  sus- 
pected of  being  diseased,  should  be  examined  microscopic- 
ally. In  foot-and-mouth  disease,  blood  and  pus  cells 
may  often  be  detected,  and  sometimes  casts  of  the  lacteal 
tubes.  In  what  is  called  garget  or  inflammation  of  the 
udder,  similar  abnormal  constituents  may  be  detected, 
while  the  colostrum,  after  calving,  is  composed  of 
agglomerations  of  fat  cells  united  by  granular  matter. 
The  normal  constituents  of  milk  as  seen  under  the 
microscope  consist  of  round  oil  globules  enveloped  in  a 
cyst  and  scattered  epithelial  cells. 

6.  Butter. —  Butter   should   give   no   unpleasant   or 
rancid  taste.     Adulteration  with  water  or  animal  fats  is 
best  detected  by  melting  the  butter  in  a  test-tube  ;  the 
water,  salt,  or  other  substances  remaining  at  the  bottom. 
After  separation  of  the  casein  by  melting,  good  butter  is 
entirely  soluble  in  ether  at  65°  Fahr.,  while  the  fat  of 
beef  or  mutton  dissolves  with  great  difficulty,  and  leaves 
a  deposit.     Adulteration  with  potato  or  other  starch  can 
be  at  once  detected  by  iodine.     Good  butter,  when  melted, 
should   yield  a   clear-looking   oil,  with  little  deposit   of 
water  or  other  substance. 

7.  Cheese. — The  quality  of  cheese  is  determined  by 
the  taste  and  consistence.     Inferior  cheeses  are  often  soft 
and  leathery,  owing  to  the  amount  of  water  which  they 
contain.     Starch,  which  is  sometimes  added  to  increase 
the  weight,  may  be  detected  by  iodine. 


48  FOOD. 

8.  Eyys. — An  average -sized  egg  weighs  about  2  oz. 
avoir.  Fresh  eggs,  when  looked  through,  are  more  trans- 
parent at  the  centre;  stale  ones,  at  the  top.  In  a  solu- 
tion of  1  of  salt  to  10  of  water,  good  eggs  sink,  while  the 
stale  ones  float. 

9. — Potatoes  should  be  of  good  size,  give  no  evidence 
of  disease,  be  firm  to  the  touch,  and,  when  cooked,  should 
not  be  close  or  watery. 

10.  Tea. — The  bloom  or  glaze  of  black  and  green  tea 
is  generally  artificial.     In  the  case  of  black  tea,  it  some- 
times consists  of  a  coating  of  black-lead  ;  and  in  that  of 
green  tea,  it  is  usually  a  mixture  of  Prussian  blue,  tur- 
meric, and  China  clay.     Both  kinds  of  adulteration  are 
detected  by  shaking  the  leaves  in  cold  water,  straining 
through   muslin,  and  afterwards  examining  the  deposit. 
Inferior  mixtures,  such  as  Maloo  mixture,  Moning  congou, 
Pekoe  siftings,  etc.,  are  largely  imported  into  this  country, 
and  consist  of  exhausted  tea-leaves,  leaves  of  other  plants, 
iron-filings,  etc.,  with  only  a  little  good  tea. 

Good  tea  should  yield  a  pleasant  aroma,  alike  in  the 
dry  state  and  when  infused  in  boiling  water,  and  the 
flavour  of  the  infusion  should  be  agreeable.  If  the  tea 
is  suspicious,  the  infused  leaves  should  be  spread  out  and 
carefully  scrutinised,  and  any  powdery  deposit  examined 
under  the  microscope. 

11.  Coffee. — The  principal  adulteration  of  coffee   is 
chicory.     The   adulteration  may  be   detected   either  by 
microscopic  examination  or  by  sprinkling  a  portion  of  the 
suspected  sample  on  the  surface  of  water,  when  the  coffee 
will  float  and  the  chicory  sink.     The  presence  of  chicory 
is  also  .indicated,  if,  on  opening  a  packet  of  coffee,  the 
contents  are  found  to  be  caked,  or  show  any  signs  of 
caking. 

Amongst  other  articles  of  food  or  drink  which  are 
liable  to  adulteration  may  be  mentioned  cocoa,  mustard, 


FOOD.  49 

pepper,  confections,  beer,  wine,  and  spirits  ;  but  without 
entering  farther  into  this  part  of  the  subject,  it  will  be 
sufficient  to  point  out  that  any  article  of  food  or  drink,  or 
any  drug  which  is  supposed  to  be  adulterated,  should  be 
submitted  to  a  public  analyst,  on  whose  report  proceedings 
may  be  taken  under  the  provisions  of  the  "  Sale  of  Food 
and  Drugs  Act,  1875." 

SECTION  VII. — THE  EFFECTS  OF  INSUFFICIENT  OR 
UNWHOLESOME  FOOD  ON  PUBLIC  HEALTH. 

1.  The  minor  effects  of  insufficient  food  are  generally 
so  intimately  associated  with  those  of  other  causes  of 
disease,  that  it  is  impossible  to  estimate,  with  any  approach 
to  accuracy,  their  separate  influence  on  public  health. 
For,  as  Mr.  Simon  eloquently  observes,  "Long  before  in- 
sufficiency of  diet  becomes  a  matter  of  hygienic  concern, 
—long  before  the  physiologist  would  think  of  counting 
the  grains  of  nitrogen  and  carbon  which  intervene  between 
death  and  starvation, — the  household  will  have  been 
utterly  destitute  of  material  comfort ;  clothing  and  fuel 
will  have  been  even  scantier  than  food  ;  against  inclem- 
encies of  weather  there  will  have  been  no  adequate  pro- 
tection ;  dwelling -space  will  have  been  stinted  to  the 
degree  in  which  overcrowding  produces  or  increases 
disease  ;  of  household  utensils  and  furniture  there  will 
have  been  scarcely  any, — even  cleanliness  will  have  been 
costly  or  difficult;  and  if  there  still  be  respectful  endea- 
vours to  maintain  it,  every  such  endeavour  will  represent 
additional  pangs  of  hunger.  The  home,  too,  will  be  where 
shelter  can  be  cheapest  bought, — in  quarters  where  there 
is  commonly  least  fruit  of  sanitary  supervision,  least 
drainage,  least  scavenging,  least  suppression  of  public 
nuisances,  least,  or  worst,  water-supply,  and,  if  in  town, 
least  light  and  air.  Such  are  the  sanitary  dangers  to 

E 


5  0  FOOD. 

which  poverty  is  almost  certainly  exposed,  when  it  is 
poverty  enough  to  imply  scantiness  of  food."  And  this 
picture,  dark  though  it  may  appear,  represents  the  con- 
dition of  thousands  who  are  struggling  hard  for  very 
existence,  and  yet  are  all  the  while  unsolicitous  of  relief. 
But  when  to  these  are  added  the  numbers  that  swell  the 
pauper  list,  and  crowd  the  workhouses,  with  the  famishing 
and  permanently  disabled,  some  conception  may  be  formed 
of  the  wide-spread  suffering  and  disease  which  follow  in 
the  wake  of  actual  want. 

The  symptoms  of  failing  health  produced  by  insuffi- 
cient diet,  as  observed  in  individual  cases,  are  somewhat 
as  follows : — There  is  gradual  loss  of  flesh,  advancing  to 
extreme  emaciation.  The  pulse  becomes  feeble,  and  the 
complexion  sallow.  Exertion  brings  on  attacks  of  palpi- 
tation, vertigo,  and  transient  blindness,  until  at  last  the 
patient  falls  a  victim  to  some  form  of  adynamic  disease. 
Of  this  train  of  symptoms  no  more  notable  example  could 
be  quoted  than  the  account  given  of  the  sanitary  condi- 
tion of  Millbank  Prison  in  1823.  The  prisoners  confined 
in  this  establishment  had  previously  received  a  daily  diet 
of  31  to  33  oz.  of  dry  nutriment,  when  it  was  resolved  to 
reduce  this  allowance  to  21  oz.,  and  to  exclude  from  the 
diet  animal  flesh,  or  nearly  so.  Hitherto,  the  prison  had 
been  considered  healthy,  but  within  a  few  months  after 
the  new  diet-scale  had  been  introduced  the  health  of  the 
inmates  began  to  give  way,  the  first  symptoms  being  loss 
of  colour,  gradual  loss  of  flesh,  and  general  debility.  At 
last,  numbers  were  attacked  with  diarrhoea,  dysentery,  and 
scurvy,  and  cases  of  convulsions,  maniacal  delirium,  and 
apoplexy,  .became  common.  About  52  per  cent  of  the 
prisoners  were  more  or  less  affected  in  this  way ;  and  to 
prove  that  the  reduction  of  the  diet  was  the  chief,  if  not 
sole  cause  of  the  epidemic,  the  prisoners  employed  in  the 
kitchen  and  who  were  allowed  8  oz.  additional  bread  daily, 


FOOD.  5 1 

continued  in  good  health,  while  the  alarming  sick-rate 
amongst  the  others  was  not  diminished  until  the  diet  was 
increased. — (Carpenter.} 

Similar  observations  to  these  were  made  amongst  the 
prisoners  confined  in  Fort  Sumter  during  the  late  Ameri- 
can war.  The  diet  of  the  30,000  inmates  consisted  of 
only  11  Ib.  meal  and-  -J-  Ib.  bacon  daily  per  head,  and 
sometimes  this  allowance  was  reduced.  As  a  consequence 
of  this  and  other  deplorable  hygienic  defects  connected 
with  the  prison,  10,000  Federals  died  within  a  period 
of  less  than  seven  months,  the  prevailing  diseases  being- 
diarrhoea,  dysentery,  scurvy,  and  hospital  gangrene.— 
(Carpenter.) 

Again,  the  terrible  mortality  which  prevailed  amongst 
the  British  troops  in  the  Crimean  war  was  to  a  very  large 
extent  attributable  to  the  insufficiency  of  the  food  supply. 
Xo  extra  allowance  was  granted  for  the  increased  exertion 
and  the  exposure  to  cold ;  and  the  result  was,  that  within 
a  few  months  the  deaths  from  diarrhoea,  dysentery,  scurvy, 
and  fever,  rose  to  39  per  cent,  and  in  some  cases  to  73. 
— (Lethely.) 

As  regards  the  civil  population,  the  history  of  relaps- 
ing fever  is  almost  exclusively  a  history  of  the  ravages 
of  disease  arising  from  destitution ;  and  the  famines  of  the 
present  century,  especially  those  of  1817  and  1847,  need 
only  be  referred  to  as  evidence  on  this  point.  Further, 
the  connection  of  scurvy  with  an  insufficient  or  badly 
arranged  dietary,  especially  among  the  sailors  of  our 
mercantile  marine,  has  all  along  been  so  notorious  that 
the  following  suggestions  regarding  sea -diet,  recently 
issued  by  the  Board  of  Trade,  may  be  fitly  quoted  here 
as  deserving  of  careful  observance  : — "  DIETARY  SCALES. — 
The  attention  of  the  Board  of  Trade  having  been  drawn 
to  the  increase  of  scurvy  on  board  British  ships  since 
1873,  a  Report  on  the  whole  subject — '  Sea-scurvy,  Food- 


52  FOOD. 

scales,  Antiscorbutics ' — has  been  recently  prepared  and 
forwarded  to  the  local  Marine  Boards  for  their  observa- 
tions.    The  conclusions  arrived  at  in  this  Eeport  were  as 
follows :    (1)  That  scurvy  has  been  on  the  increase  in 
British  ships  since  1873.     (2)  That  lime-juice,  of  itself, 
will  not  prevent  scurvy,  and  that  too  much  reliance  is 
placed  on  it,  to  the  neglect  of  varied  food-scales.      (3) 
That  lime-juice,  in   connection   with   fresh   or   preserved 
meat  and  vegetables,  may  prevent  scurvy.      (4)  That  the 
dietary  scale  of  ships  should  therefore  include  a  fair  pro- 
portion of  fresh  and  preserved  meats,  as  distinguished 
from  salted  meats.     (5)  That  more  fresh  vegetables  should 
be  carried,  notably  raw  potatoes.     No  satisfactory  reason 
is  given  why  fresh  potatoes  cannot  be  carried  on  board 
British  ships.     The  allegation  that  they  will  not  keep 
good  on  board  ship  is  clearly  disproved  by  the  fact  that 
they  do  keep  on  board  United  States  ships,  and  will  keep 
for  a  fair  time  anywhere  else.     (6)  That  it  is   not  at 
present  desirable  to  insert  a  statutory  scale  of  diet  in  the 
articles  of  agreement  with  crews  serving  on  long  voyages, 
though  it  may  possibly  be  necessary  hereafter,  unless  the 
shipowners  themselves  move  in  the  matter.     The  replies 
received  from  the  local  Marine  Boards  have  confirmed 
these  views,  especially  as   regards  the   articles   of    diet 
referred   to   therein,  and    superintendents   are    therefore 
requested  to  take  every  opportunity  of  urging  upon  owners 
of  vessels  sailing  on  long  voyages  the  necessity  of  sup- 
plying their  crews  with  fresh  potatoes,  molasses,  etc.,  and 
a  larger  supply  of  fresh  or  preserved  meats,  in  lieu  of  salt 
beef  or  pork." — Report  Marine  Department,  1883. 

2.  Unwholesome  Food. — There  is  so  much  uncertainty 
with  regard  to  the  effects  of  eating  what  is  called  unsound 
meat  that  Dr.  Letheby  has  observed :  "  I  feel  that  the 
question  of  the  fitness  of  such  meat  for  food  is  in  such  an 
unsettled  state  that  my  action  in  the  matter  is  often  very 


FOOD.  53 

uncertain  ;  and  I  should  like  to  have  the  question  experi- 
mentally determined  ;  for,  as  it  now  stands,  we  are  either 
condemning  large  quantities  of  meat  which  may  be  eaten 
with  safety,  and  are  therefore  confiscating  property,  and 
lessening  the  supply  of  food ;  or  we  are  permitting  un- 
wholesome meat  to  pass  almost  unchallenged  in  the  public 
markets."  No  doubt,  much  of  the  apparent  immunity 
from  disease  enjoyed  by  the  large  numbers  who  unwit- 
tingly indulge  in  unwholesome  food  at  times,  is  to  be 
attributed  to  the  antiseptic  power  of  good  cooking,  but 
there  are  also  many  instances  on  record  in  which  food  of 
the  most  putrid  description  is  devoured  without  producing 
any  ill  effects.  Thus,  according  to  Sir  Eobert  Chris tison, 
there  are  whole  tribes  of  savages  who  «at  with  impunity 
rancid  oil,  putrid  blubber,  and  stinking  offal;  and  in  this 
country  game  is  not  considered  to  be  in  a  fit  state  for  the 
epicure's  table  until  it  is  undergoing  rapid  putrefactive 
change.  Admitting  all  this,  however,  there  is  abundant 
(-vidence  to  prove  that  serious  consequences  resulting  from 
the  use  of  unsound  meat  are  of  frequent  occurrence,  and 
in  all  probability  a  large  proportion  of  cases  of  obscure 
disease  owe  their  origin  to  the  same  cause.  Moreover,  it 
is  but  only  logical  to  conclude,  from  general  principles, 
that,  as  all  diseases  must  affect  the  composition  of  animal 
flesh,  and  as  active  putrefactive  change  must  at  all  events 
deteriorate  its  nutritive  value,  it  is  of  the  utmost  import- 
ance to  health  that  these  substances  should  be  obtained 
in  as  sound  a  condition  as  possible. 

The  following  is  a  brief  abstract  of  the  more  import- 
ant facts  connected  with  this  part  of  the  subject : — 

(1.)  Putrid  Meat. — On  the  whole,  this  may  be  said 
t«>  }»e  wasteful  rather  than  positively  injurious,  but  there 
are  numerous  cases  recorded  in  which  it  has  produced 
serious  disease.  Vomiting,  diarrhoea,  and  low  fever  of  a 
typhoidal  type,  are  the  chief  symptoms.  Putrid  sausages 


54  FOOD. 

are  especially  dangerous.  According  to  an  official  return, 
it  appears  that  in  Wurtemberg  alone,  during  the  last 
fifty  years,  there  have  been  400  cases  of  poisoning  from 
German  sausages,  and  of  these  140  were  fatal. 

(2.)  Diseased  Meat. — Here,  again,  the  evidence  is 
of  the  same  conflicting  character.  According  to  Dr. 
Letheby,  enormous  quantities  of  the  flesh  of  animals 
that  died  of  rinderpest  in  1863,  and  more  recently  of 
pleuro-pneumonia,  have  been  sent  to  the  London  market, 
sold,  and  eaten,  without  having  produced  any  tangible 
ill  effects.  It  is  also  well  known  that  Scotch  shepherds 
indulge  largely  in  Iraxy,  or  diseased  mutton,  with  ap- 
parent impunity:  and,  according  to  M.  Decroix,  the 
whole  of  the  inhabitants  of  Paris  would  have  suffered 
during  the  late  siege  if  diseased  meat  were  to  any  extent 
dangerous. 

In  the  face  of  such  evidence  as  this,  it  really  becomes 
a  question  of  public  importance  whether  the  flesh  of  all 
animals  that  have  died  diseased  should  be  condemned. 
As  a  matter  of  fact,  about  one-fifth  of  the  meat  in  the 
London  market,  according  to  Professor  Gamgee,  is  of  this 
description ;  and  it  has  been  urged  that,  if  it  were  sold 
under  its  true  character;  and  proper  precautions  were  taken 
with  regard  to  selection  and  cooking,  the  ill  effects  which 
sometimes  attend  its  use  might  not  occur.  It  has  been 
urged,  too,  that  though  such  meat  would  be  of  inferior 
quality,  it  would  be  much  cheaper,  and  thus  come  within 
the  reach  of  many  who  are  sorely  in  want  of  animal  flesh, 
but  cannot  buy  it  at  its  present  price.  As  it  is,  however, 
the  butcher  sells  it  under  a  fictitious  character,  and  it  is 
therefore  the  duty  of  the  health  officer  to  condemn  it. 

In  the  numerous  cases  of  illness  which  have  been 
attributed  to  the  use  of  diseased  meat,  the  symptoms  are 
very  similar  to  those  occasioned  by  the  use  of  putrid  meat. 
The  exceptional  symptoms  apply  chiefly  to  the  trans- 


FOOD.  5  5 

mission  of  specific  or  parasitic  disease.      Thus  instances 
have  been  recorded  in  which  persons  have  been  seized 
with  malignant  pustule  after  eating  the  meat  of  animals 
suffering  from  anthrax ;  and  Dr.   Creighton,  in  a  paper 
read  before  the  International  Medical  Congress,  1881,  has 
aroused  grave  doubts  as  to  whether  tuberculosis  may  not 
be  transmitted  to  man  through  eating  the  flesh  of  animals 
suffering  from  this  disease.     Sausages  and  pork-pies  have 
been  frequently  known  to  induce  symptoms  of  irritant 
poisoning,  and  this  is  not  to  be  wondered  at,  considering 
the  vast  quantities  of  diseased  meat  that  are  used  up  in 
this  way.     As  regards  the  development  of  parasitic  disease, 
reference  need  only  be  made  to  the  fact  that  the  Cysticer- 
cvj  celluloses  in  measly  pork  produces  the  Tcenia  solium, 
and  that  of  the  ox  or  cow  the   Tcenia  medio-canellata. 
The  trichina  disease,  again,  which  was  so  prevalent  in 
(lermany  and  elsewhere  a  few  years  ago,  is  due  to  the 
Trichina  spiralis  in  the  pig ;  while  the  ccchinoccus  disease, 
so  common  in  Iceland,  owes  its  origin  to  the  flesh  of 
sheep   and   cattle   which   have  become   infested   by  the 
toenia  of  the  dog.     It  appears  that  all  these  parasites 
arc  destroyed  if  the  meat  is  thoroughly  cooked  before 
•  •ill  ing. 

One  of  the  most  remarkable  outbreaks  which  have 
recently  been  investigated  in  connection  with  diseased 
meat  occurred  among  persons  attending  the  sale  of  the 
late  Duke  of  Portland's  effects  at  Wellbeck,  Notts,  in 
June  1880.  Dr.  Ballard,  who  was  appointed  to  conduct 
the  inquiry,  found  that  as  many  as  seventy- two  persons 
wore  attacked  with  intense  diarrhoea,  with  febrile  symptoms, 
after  partaking  of  luncheon,  and  four  of  the  cases  proved 
fatal.  From  among  the  various  articles  of  food  or  drink 
which  were  partaken  of  at  the  luncheon,  he  was  able  to 
exclude  everything  except  the  ham  and  beef  as  being 
in  any  way  implicated  in  the  production  of  the  disease, 


5  6  FOOD.     . 

while  other  considerations  suggested  the  hams  or  some  of 
them  as  being  most  probably  at  fault.  Microscopical  ex- 
amination of  the  provisions  then  showed  that  the  hams 
were  infested  not  with  Trichinae,  but  with  a  special 
Bacillus  not  previously  known ;  while  numerous  specimens 
of  this  Bacillus  were  found  in  the  kidney  of  one  of  the 
fatal  cases  on  post-mortem  examination.  Further,  Dr. 
Klein,  on  feeding  small  animals  on  portions  of  the 
suspected  ham,  or  inoculating  them  with  it,  developed  in 
them  similar  symptoms  to  those  from  which  the  infected 
persons  had  suffered,  and  many  of  them  died  with  acute 
inflammatory  disease  of  one  organ  or  another ;  while 
Bacilli,  taken  from  two  of  the  hams  and  cultivated  in 
white  of  egg,  produced  on  inoculation  similar  results. 
Another  outbreak  of  much  the  same  character  was  in- 
vestigated by  Dr.  Ballard  in  February  1881,  and  occurred 
at  Nottingham.  In  this  outbreak  it  was  found  that  after 
eating  baked  pork,  fifteen  persons  were  attacked,  and  one 
died.  In  this  instance,  no  specimen  of  the  meat  could 
be  obtained,  but  numerous  Bacilli  were  found  in  the  body 
of  the  patient  who  had  died.  (Report  of  the  Medical 
Officer  of  the  Local  Government  Board,  1881.) 

(3.)  Some  kinds  of  fish,  especially  in  warm  weather 
and  in  hot  climates,  have  been  known  to  produce  very 
severe  symptoms.  Thus  cases  of  acute  urticaria,  with 
swelling  of  the  tongue,  fauces,  and  eyelids,  are  frequently 
due  to  eating  lobsters,  crabs,  or  shell-fish ;  while  gastro- 
intestinal irritation,  sometimes  of  almost  choleraic  inten- 
sity, is  by  no  means  a  rare  consequence  of  eating  putrid 
fish  of  any  kind.  The  disease  known  by  the  Spanish 
name  of  siguatera  is  of  this  description,  and  is  common 
amongst  the  crews  of  vessels  doing  duty  in  the  tropics 
when  they  partake  of  fish  caught  at  the  various  stations 
as  a  change  from  the  ordinary  diet  of  the  ship. 

(4.)  As  regards  unwholesome  vegetable  food,  it  may 


FOOD. 

be  said  that  all  food  of  this  description  which  has  bt 
mouldy  is  dangerous.      On  the  Continent,  the  ergot  oi 
has  been   productive   of  serious   epidemics,  and  in  t, 
country  alarming  symptoms  have  frequently  followed  tlu 
use  of  flour  which  contains  the  ground  seeds  of  Lolium 
temulentum,  or  darnel. 

In  connection  with  the  subject  of  unsound  food, 
special  notice  should  be  taken  of  the  spread  of  disease 
through  the  agency  of  milk.  And,  first,  it  has  to  be 
noted  that  the  milk  of  animals  suffering  from  disease,  as 
from  foot-and-mouth  disease,  though  no  doubt  frequently 
used  with  impunity,  sometimes  produces  aphthous  ulcera- 
tion  of  the  mouth  and  gums,  with  swelling  of  the  tongue 
and  great  foetor  of  the  breath.  Dr.  Thorne  reports  an 
outbreak  of  this  nature  (see  Twelfth  Report  of  the  Medical 
Officer  of  Privy  Council),  and  I  have  myself  witnessed  a 
few  well-marked  cases  of  this  description.  Dr.  Paine, 
Medical  Officer  of  Health,  Cardiff,  found  that  concurrently 
with  an  epidemic  of  foot-and-mouth  disease  in  the  town, 
a  severe  form  of  sore-throat  became  prevalent  amongst 
children  in  the  infected  neighbourhood,  and  microscopic 
examination  of  the  milk  led  him  to  believe  that  this  was 
the  cause.  (Sanitary  Record,  1879.) 

Although  it  may  be  quite  true  that  the  milk  of 
diseased  cows  has  often  been  used  without  producing 
any  appreciable  ill  effects,  still  there  is  always  a  certain 
amount  of  risk,  and  on  that  account  it  cannot  be  too 
strongly  insisted  on  that  all  milk  of  the  kind,  or  indeed 
any  milk  yielded  by  a  cow  suffering  from  any  form  of 
disease,  should  be  condemned  as  unfit  for  human  food. 
In  the  Western  States  of  America  the  milk  of  cows 
affected  with  "  the  trembles,"  believed  to  be  produced  by 
feeding  on  Rhus  toxicodendron,  has  frequently  been  known 
to  cause  severe  gastric  symptoms  amongst  children,  accom- 
panied by  groat  weakness  and  lowering  of  the  tempera- 


58  FOOD. 

ture  (see  Medical  Times  and  Gazette,  1868).  In  this 
country  very  strong  fears  have  likewise  been  expressed  by 
the  •  opponents  to  schemes  of  sewage  irrigation,  that  the 
milk  of  cows  fed  on  sewaged  grass  would  be  unwhole- 
some  and  the  butter  become  putrid.  But,  so  far  as  I  am 
aware,  there  is  no  well-authenticated  instance  of  disease 
having  been  produced  in  this  way,  while  I  can  assert 
to  the  contrary  that  there  are  large  quantities  of  milk 
sold  daily  in  and  around  Leamington  obtained  from  cows 
fed  exclusively  on  sewaged  grass  during  the  summer,  and 
that  on  every  occasion  on  which  samples  of  the  milk  have 
been  analysed,  it  has  been  found  to  be  richly  flavoured 
and  of  excellent  quality.  It  may  also  be  noted  that 
several  analysts  have  made  repeated  experiments  with 
the  butter,  and  have  found  that  it  possesses  none  of  those 
tendencies  to  putrefactive  change  which  have  been  so 
gratuitously  attributed  to  it. 

But  the  great  danger  attaching  to  milk,  as  a  carrier  of 
disease,  depends  upon  its  remarkable  powers  of  absorption 
and  the  rapid  fermentive  or  zymotic  changes  which  it 
undergoes  when  it  becomes  mixed  with  putrefying  matter, 
or  tainted  with  disease -germs.  Some  few  years  ago  it 
was  proved  by  Mr.  Lawson  Tait,  and  the  experiment  has 
since  been  repeated  by  others,  that  milk  exposed  to  the 
vapour  of  carbolic  acid,  for  example,  will  very  soon  taste 
strongly  of  the  acid ;  and  in  like  manner,  if  it  be  kept  in 
any  close  or  badly- ventilated  place,  where  foul  odours  are 
perceptible,  it  will  very  soon  become  tainted  and  unfit  for 
use.  Very  probably,  it  is  in  this  way  that  such  fungi  as 
the  Oidium  lactis,  described  by  Fuchs,  Hosier,  and  Hess- 
ling,  are  generated,  and  it  is  well  known  that  milk  so 
affected  has  frequently  been  the  cause  of  gastric  irritation 
and  sharp  attacks  of  vomiting.  Moreover,  there  can  be 
no  doubt  that  much  of  the  infantile  diarrhoea,  which  proves 
specially  fatal  during  the  summer  and  autumn  months,  is 


FOOD.  59 

due  to  milk,  which  either  becomes  tainted  in  this  way,  or 
becomes  tainted  by  being  put  into  feeding-bottles  which 
are  seldom  or  never  properly  cleaned.  Indeed,  there  are 
so  many  unseen  dangers  in  the  use  of  milk,  especially 
amongst  careless  and  filthy  people,  that,  to  insure  safety, 
it  should  always  be  boiled  during  warm  weather,  and 
particularly  in  districts  where  foot-and-mouth  disease  is 
prevalent.  Milk  should  never  be  stored  in  sculleries  or 
larders,  or  in  vessels  made  of  lead  or  zinc ;  in  the  latter 
case  it  speedily  absorbs  salts  of  the  metal  and  becomes 
poisonous. 

As  regards  the  spread  of  specific  disease,  there  is  now 
an  overwhelming  amount  of  evidence  which  proves,  be- 
yond dispute,  that  milk  is  largely  instrumental  in  propa- 
gating scarlatina  and  enteric  fever;  and  amongst  other 
instances  may  be  mentioned  the  following : — The  late 
Professor  Bell  of  St.  Andrews  has  related  an  outbreak  of 
scarlet  fever  in  that  town,  which  showed  very  conclusively 
that  the  fever  was  distributed  by  the  milk-carrier,  or,  what 
is  more  probable,  that  the  diseased  cuticle  from  the  woman 
and  children  who  vended  the  milk  actually  passed  into 
it,  and  that  in  this  way  the  poison  was  introduced.— 
(Lancet,  1870.)  Again,  Dr.  Taylor  of  Penrith  gives  an 
account  of  a  somewhat  similar  outbreak,  in  the  British 
Medical  Journal,  1870,  where  he  also  reports  a  group  of 
cases  of  enteric  fever  which  he  believed  to  be  due  to 
specifically  infected  milk.  Further,  Dr.  Ballard  (Lancet, 
1870)  records  an  outbreak  of  enteric  fever  in  Islington, 
which  he  attributed  to  the  washing  of  the  milk-cans  with 
water  derived  from  a  tank  which  was  found  to  communi- 
cate with  two  old  drains,  and  one  of  these  with  the  pipe 
of  a  water-closet.  Whether  the  milk  was  adulterated 
with  the  same  water  was  not  ascertained,  but  the  evidence, 
both  positive  and  negative,  rendered  it  tolerably  certain 
that  the  disease  was  propagated  in  this  way.  These  out- 


6  0  FOOD. 

breaks  were  the  first  of  the  kind  which  were  thoroughly 
investigated,  but  since  then  numerous  others  have  been 
reported ;  as,  for  example,  the  outbreak  at  Armley,  a 
village  near  Leeds,  investigated  by  Dr.  Eobinson  and  Dr. 
Ballard  in  1872  ;  an  outbreak  at  East  Molesey,  near 
Birmingham,  also  investigated  by  Dr.  Ballard  in  1873; 
an  outbreak  at  Parkhead,  a  suburb  of  Glasgow,  investi- 
gated by  Dr.  Eussell  in  1873  ;  and  the  well-known  out- 
break at  Marylebone,  London,  the  real  cause  of  which 
was,  in  the  first  instance,  suspected  by  the  late  Dr. 
Murchison  and  others,  and  was  subsequently  investigated 
in  all  its  intricate  bearings  by  Mr.  Netten  Kadcliffe, 
assisted  by  Mr.  Power.  In  this  instance  the  disease  ap- 
peared within  a  few  weeks  in  as  many  as  123  families, 
of  whom  106  obtained  their  milk  from  a  new  milk  com- 
pany ;  and  Mr.  Kadcliffe  proved  with  "  a  probability 
amounting  for  practical  purposes  to  a  certainty,  that— 

"  (1.)  The  outbreak  of  enteric  fever,  which  formed 
the  subject  of  inquiry,  was  caused  by  milk  infected  with 
enteric  fever  material. 

"  (2.)  That  this  came  from  a  particular  farm. 
"  (3.)  That  the  water  used  for  dairy  purposes  on  this 
farm  contained  excremental  matters  from  a  patient  suffer- 
ing from  enteric  fever,  immediately  before  and  at  the 
time  of  the  outbreak." — (See  Mr.  Simon's  Reports,  New 
Series,  No.  II.) 

In  a  paper  read  before  the  International  Medical 
Congress  in  1881,  Mr.  Ernest  Hart  gave  a  tabulated 
account  of  as  many  as  71  epidemics  due  to  infected  milk, 
67  of  which  had  been  made  the  subject  of  detailed  in- 
quiry since  the  date  of  the  Marylebone  outbreak.  Of 
these  5  0  were  epidemics  of  enteric  fever,  1 4  of  scarlatina, 
and  7  of  diphtheria ;  while  the  number  of  cases  traceable 
to  each  of  these  diseases  in  the  various  outbreaks  was  esti- 
mated at  3500,  800,  and  500  respectively.  As  regards 


FOOD.  61 

enteric  fever,  the  contamination  of  the  milk  was  in  22 
out  of  the  50  epidemics  traced  to  the  use  of  specifically 
polluted  water  for  "  washing  the  milk-cans,"  and  no  doubt 
in  all  of  them  water  was  the  prime  agent  in  producing 
the  disease.  In  outbreaks  of  scarlatina,  on  the  other 
hand,  the  milk  absorbs  the  contagium  given  off  by  the  skin 
and  lungs,  and  in  the  majority  of  recorded  outbreaks  it 
has  been  found  that  persons  employed  in  the  dairy  were 
in  attendance  on  patients  suffering  from  the  disease,  or 
that  the  disease  itself  existed  in  the  dairy.  But  with 
regard  to  diphtheria,  the  exact  exciting  cause  has  not  been 
so  easily  traced.  In  a  report  presented  to  the  Local 
Government  Board,  Mr.  Power,  in  describing  an  outbreak 
of  diphtheria  which  occurred  in  North  London  in  1878, 
was  led  to  the  conclusion  that  garget  or  inflammation  of 
the  udder  of  the  cow  may  have  induced  the  disease,  but 
this  conjecture  has  not  been  corroborated  by  other  in- 
quiries. Very  probably  in  diphtheria,  the  milk  becomes 
sometimes  tainted  through  aerial  agency,  the  breath  being 
the  contaminating  agent ;  and  as  we  know  that  diphtheria 
is  frequently  traced  to  polluted  water,  it  may  be  reason- 
ably supposed  that  milk  tainted  with  such  water  would 
also  produce  the  disease.  Kecent  outbreaks  of  diphtheria 
traced  to  milk-supplies  have  occurred  in  Plymouth,  Hen- 
don,  and  the  north  of  London. 

But  in  addition  to  diphtheria,  certain  obscure  throat 
affections  have  been  recently  traced  to  a  tainted  milk- 
supply,  and  notably  an  outbreak  which  occurred  in 
Aberdeen  in  1881.  In  this  outbreak  the  sufferers  were 
attacked  by  severe  rigors,  followed  by  febrile  symptoms 
and  extreme  prostration.  The  tonsils  were  slightly  en- 
larged, but  there  was  no  false  membrane,  while  a  marked 
feature  was  the  swelling  of  the  glands  of  the  neck  and 
those  above  the  clavicle.  Over  300  persons  sickened 
within  a  short  time,  and  90  families  were  attacked  out 


62  FOOD. 

of  a  total  of  110  supplied  by  the  same  dairy.  So  soon 
as  the  milk-supply  was  stopped,  the  farther  spread  of  the 
disease  was  at  once  arrested ;  indeed,  its  disappearance 
was  as  sudden  as  its  onset.  In  this  instance  the  water- 
supply  was  obtained  from  an  uncovered  cistern  in  the 
cow -shed,  and  on  analysis  it  was  found  to  be  polluted ; 
but  though  suspicion  attached  to  the  water,  the  abrupt- 
ness of  the  outbreak  points  rather  to  some  temporary 
tainting  agency  which  was  not  discovered,  although  it 
was  found  to  be  connected  with  minute  organisms  in  the 
milk.  (Sanitary  Record,  1881.) 

Although  other  serious  outbreaks  might  be  quoted, 
these  are  sufficient  to  prove  that  milk  is  a  far  more 
frequent  agent  in  the  spread  of  disease  than  is  generally 
suspected ;  and,  for  my  own  part,  I  am  inclined  to  be- 
lieve that  many  obscure  cases  of  enteric  fever,  and  much 
of  the  autumnal  diarrhoea,  which  occur  in  rural  districts, 
are  due  to  polluted  milk.  Indeed,  several  scattered 
cases  of  enteric  fever  have  come  under  my  own  notice, 
in  which,  although  there  was  no  evidence  to  show  that 
the  specific  virus  had  been  introduced,  it  was  clear 
enough  that  the  well  was  contaminated  with  sewage, 
and  that  the  milk -cans  had  been  washed  with  the  pol- 
luted well-water,  even  if  the  milk  itself  had  not  been 
diluted  with  it. 

So  far  the  inspection  of  dairies  and  cow-sheds,  under 
the  Code  of  Eegulations  issued  by  the  Privy  Council  in 
1879,  has  been  of  very  doubtful  benefit,  and  indeed  in 
most  parts  of  the  country  the  code  has  not  been  put 
into  operation.  The  duties  ought  certainly  to  be  trans- 
ferred from  the  County  to  the  Sanitary  Authorities. 
(See  Appendix.) 


EFFECTS  OF  IMPURE  ATR  ON  PUBLIC  HEALTH.  03 


CHAPTER   III. 

AIR  :    ITS  IMPURITIES,  AND  THEIR  EFFECTS  ON  PUBLIC 
HEALTH. 

SECTION  I. — COMPOSITION.  j4  ^ 

PURE  AIR,  according  to  the  numerous  analyses  of  Dr. 
Angus  Smith,  is  composed  of  20*99  per  cent  by  volume 
of  oxygen,  '033  per  cent  of  carbonic  acid,  and  the  rest  of 
nitrogen,  watery  vapour,  and  traces  of  ammonia.  With 
the  exception  of  carbonic  acid  and  aqueous  vapour,  the 
relative  proportions  of  the  other  constituents  remain 
tolerably  constant  throughout  the  globe.  In  this  country 
the  amount  of  oxygen  varies  from  20*999  per  cent  in  the 
sea  air  on  the  coast  of  Scotland,  to  20*910  in  Manchester 
(luring  frost  and  fog,  while  the  carbonic  acid  ranges  from 
*03  to  *05  per  cent.  The  following  averages  of  analyses, 
quoted  from  Dr.  Smith's  work  on  Air  and  Rain,  represent 
the  more  important  variations  in  the  open-air  percentages 
of  carbonic  acid  : — 

Carbonic  Acid 

in  100  parts. 

Averages. 

Different  parts  of  Scotland,  and  at  various  altitudes  .  '0336 

Perth  City  and  outskirts         .             .             .             .  "04136 

Closer  parts  of  Glasgow           ....  '0539 

Opener  parts  of  Glasgow         ....  '0461 

Suburbs  of  Manchester           ....  "0369 

Streets  of  Manchester              ....  '0403 

Open  places  of  London            ....  '0301 

Streets  of  London        .....  "0341 

Lake  of  Geneva  (S.iussur.-'s  analysis)  -0439 


64  AIR:    ITS  IMPURITIES, 

It  also  appears  that  the  air  of  the  highest  mountains  con- 
tains more  carbonic  acid,  less  oxygen,  and  less  organic 
matter,  than  the  air  of  plains,  and  that  the  quantity  of 
oxygen  is  always  sensibly  diminished  in  the  air  of  towns. 

The  amount  of  aqueous  vapour  fluctuates  greatly,  and 
is  mainly  influenced  by  temperature.  At  a  given  tem- 
perature air  cannot  contain  more  than  a  certain  quantity 
of  moisture  in  suspension,  and  when  it  has  taken  up  this 
quantity  it  is  said  to  be  saturated.  In  general,  the  air 
H  contains  from  50  to  75  per  cent  of  the  amount  requisite 
for  complete  saturation,  the  average  amount  being  about 
1*46  in  100  parts.  If  the  quantity  be  not  within  these 
limits,  the  air  is  either  unpleasantly  dry  or  moist. 

The  ammonia,  which  exists  as  carbonate,  chloride, 
sulphate,  or  sulphide,  is  present  only  in  very  minute 
quantities,  and  does  not  exceed  one  part  in  a  million  parts 
of  air. 

In  addition  to  these  ingredients,  ozone  may  perhaps 
be  reckoned  as  a  normal  constituent,  "and  spectroscopic 
analysis  has  shown  that  the  salts  of  sodium  are  every- 
where present  in  greater  or  less  abundance. 


SECTION  II. — IMPURITIES  IN  AIR,  AND  THEIR  EFFECTS 
ON  PUBLIC  HEALTH. 

Preliminary  Remarks.  —  Impurities  in  air  may  be 
roughly  divided  into  suspended  and  gaseous  matters. 
While  the  presence  of  suspended  matters  is  rendered 
familiar  to  every  one  in  the  shining  particles  which 
become  visible  in  the  direct  rays  of  the  sun,  the  well- 
known  demonstrations  by  Professor  Tyndall  with  the 
electric  light  have  shown,  perhaps  more  forcibly  than 
heretofore,  their  almost  universal  diffusion.  Particles  of 
silica  and  silicates,  of  calcium  carbonates  and  phosphates, 
of  iron  salts,  and,  in  short,  of  every  chemical  constituent 


AXD  THEIR  EFFECTS  OX  PUBLIC  HEALTH.  65 

of  the  soil,  are  lifted  by  the  winds  and  carried  hither  and 
thither.  In  inhabited  places,  carbon  particles,  hairs, 
fibres  of  cotton,  wool,  and  other  fabrics,  starch-cells,  etc., 
are  found  in  great  abundance.  From  the  vegetable  world 
are  wafted  seeds  and  the  dAlris  of  vegetation,  as  well  as 
spores,  germs,  pollen,  and  volatile  substances.  In  like 
manner,  the  animal  kingdom  supplies  germs  of  vibriones, 
bacterise,  and  monads,  and  particles  of  decayed  or  decay- 
ing tissues,  such  as  epithelium  and  pus  cells. 

The  numerous  gaseous  matters  which  pass  into  the 
atmosphere,  and  render  it  impure,  will  be  more  con- 
veniently noticed  in  the  subsequent  remarks  concerning 
overcrowding,  aud  the  injurious  effects  of  different  trades 
and  manufactures. 

But  there  are  other  organic  vapours  arising  from  the 
decomposition  of  vegetable  and  animal  products  which 
merit  special  attention,  as,  for  example,  those  contained 
in  the  air  of  marshes  and  sewers.  The  exact  chemical 
composition  of  these  vapours  still  remains  a  mystery. 
Equally  obscure  too  is  the  nature  of  those  organic  sub- 
stances which  constitute  the  specific  poisons  of  contagious 
diseases.  Whether  they  consist  of  inconceivably  minute 
particles  of  decaying  matter,  or  of  living  microscopic 
germs ;  whether,  in  some  instances,  they  are  conveyed  by 
epithelium  and  pus  cells  from  the  diseased  to  the  healthy, 
or  are  condensed  with  the  watery  vapour  of  the  atmo- 
sphere, and  thus  disseminated  ; — all  these  are  questions 
which  have  yet  to  be  satisfactorily  answered.  Certain  it 
is,  that  in  a  large  proportion  of  cases  the  atmosphere  is 
made  the  vehicle  of  the  coutagium  or  morbific  agent, 
whatever  its  nature;  and  hence  the  paramount  importance 
of  adopting  such  measures  as  will  prevent  contamination 
of  the  air ;  or  at  all  events  aid  in  dissipating  or  destroy- 
ing its  more  noxious  impurities.  It  is  true  some  of  the 
operations  of  Nature  are  in  themselves  calculated  to 

F 


66  AIR:    ITS  IMPURITIES, 

accomplish  this  end.  Injurious  gases  become  diffused, 
diluted,  or  decomposed ;  animal  emanations  are  absorbed 
in  the  processes  of  vegetation ;  suspended  matters  are 
wasjied  down  by  the  rains,  or  fall  by  their  own  weight ; 
while  many  organic  substances  are  oxidised,  and  thus 
rendered  innocuous.  Were  it  not  for  these  purifying 
agencies,  which  are  in  constant  activity,  sanitary  measures 
would  prove  futile ;  and,  indeed,  they  are  only  successful 
in  so  far  as  they  approximate  to  the  preventive  and 
remedial  means  which  Nature  employs. 

1.  Air  vitiated  ly  Respiration. — The  effete  matters 
thrown  off  in  respiration  are  carbonic  acid,  watery  vapour, 
and  certain  undefined  organic  substances. 

According  to  Dr.  Carpenter,  who  has  summarised  the 
results  obtained  by  various  physiologists,  an  adult  man, 
under  ordinary  circumstances,  gives  off  1 6  0  grs.  of  carbon 
per  hour.  In  both  sexes  the  amount  increases  up  to 
about  the  thirtieth  year,  but  beyond  the  eighth  year  the 
exhalation  is  greater  in  males  than  in  females.  Dr. 
ft  Parkes  has  given  the  average  amount  of  carbonic  acid 
exhaled  by  an  adult  in  the  twenty-four  hours  as  16  cubic 
feet,  or  a  little  over  '6  cubic  feet  per  hour. 

The  quantity  of  watery  vapour  thrown  off  by  the  skin 
and  lungs  varies  according  to  the  hygrometric  condition 
of  the  atmosphere.  It  has  been  estimated  at  from  2  5  to 
40  oz.  in  the  24  hours,  and  requires,  on  the  average,  210 
cubic  feet  of  air  per  hour  to  retain  it  in  a  state  of  vapour. 

The  organic  matter  given  off  has  never  been  accu- 
rately determined.  It  has  a  very  foetid  smell,  and  is  but 
slowly  oxidised.  It  is  believed  'to  be  molecular,  and  may 
be  said  to  hang  about  a  room  like  clouds  of  tobacco- 
smoke,  and,  like  tobacco-smoke,  the  odour  is  difficult  to 
be  got  rid  of,  even  after  free  ventilation  has  been  resorted 
to.  It  darkens  sulphuric  acid,  and  decolourises  solutions 
of  potassium  permanganate.  When  drawn  through  pure 


AND  THEIR  EFFECTS  OX  PUBLIC  HEALTH. 


water  it  renders  it  very  offensive.  It  is  certainly  nitro- 
genous, and  probably  in  combination  with  water,  because 
hygroscopic  substances  absorb  it  most  readily.  According 
to  Lemaire,  Trautman,  and  others,  it  contains  minute 
cellular  bodies  named  "putrefaction -cells,"  which  have 
been  found  to  bear  a  close  resemblance  to  the  so-called 
bacteriform  puncta  which  Dr.  Macdonald  of  Netley  has 
detected  in  foul  water.  In  sick-rooms  it  is  associated 
with  pus-cells  and  other  emanations  of  disease.  As  much 
as  46  per  cent  of  organic  matter  has  been  found  in  plaster 
taken  from  the  walls  of  a  hospital  ward  in  Paris. 

As  the  ammonia,  and  more  especially  the  albuminoid, 
may  be  taken  as  an  index  of  the  amount  of  organic  im- 
purities contained  in  air  collected  at  various  places,  the 
following  summary  of  analyses,  by  Dr.  Angus  Smith,  is 
instructive  : — 


Air  obtained  from 

No.  of 
Experi- 
ments. 

Free  Ammonia. 
Grains  per 
Million 
cubic  feet. 

Albuminoid 
Ammonia. 
Grains  per 
Million, 
cubic  feet. 

Total 
Ammonia. 
Grains  per 
Million 
cubic  feet. 

lunellan    (on    the 

banks   of   the 

Clyde)  .     .     . 

1 

22-845 

60-228 

83-073 

London  .... 

18 

26780 

65-947 

92727 

Glasgow  . 

4 

34-169 

133-264 

167-483 

A  bed-room  .     .     . 

3 

44-305 

104-118 

148-423 

A  midden     .     .     . 

3 

146-911 

181-524 

328-435 

According  to  a  report  on  the  air  of  Glasgow  by  Dr. 
Russell  and  Mr.  Dunnachie,  published  in  May  1879, 
nitrogen,  as  free  and  albuminoid  ammonia,  was  found  to 
be  always  in  excess  in  the  two  centric  stations  of  obser- 
vation in  the  city,  when  compared  with  analyses  made  of 
the  air  collected  at  an  excentric  station,  but  it  was  also 
found  that  the  amount  of  potential  or  albuminoid  am- 
monia became  much  lower  in  the  month  of  July,  clearly 
showing,  especially  when  the  amount  of  sulphur  is  taken 


68  AIR:    ITS  IMPURITIES, 

into  account,  that  both  forms  of  ammonia  are  "largely 
derivatives  of  the  rapid  combustion  of  fire  applied  to  wood 
or  coal."  These  experiments  have  been  confirmed  to  a 
certain  extent  by  those  which  have  been  carried  on  for 
some  time  back  at  the  observatory  of  Mountsouris,  in  the 
neighbourhood  of  Paris,  and  serve  to  prove  that  the 
amount  of  ammoniU  cannot  be  relied  on  as  an  index  of 
the  insalubrity  of  air  without  taking  into  account  the 
natural  history  of  each  sample. 

Practically  speaking,  the  amount  of  organic  matter 
ii  in  air  vitiated  by  respiration  is  found  to  increase  as  the 
carbonic  acid  increases.  According  to  Dr.  Parkes  it 
becomes  distinctly  perceptible  to  the  sense  of  smell  when 
the  carbonic  acid,  in  an  inhabited  room  amounts  to  '7 
per  1000  cubic  feet  of  air — a  statement  which  has  been 
frequently  verified  by  other  experimenters.  *6> 

Briefly,  then,  the  changes  produced  in  an  occupied 
air-space  by  respiration  and  transpiration  are  the  follow- 
ing:—  The  amount  of  oxygen  is  greatly  lessened,  the 
carbonic  acid  and  watery  vapour  are  largely  increased, 
ammonia  and  organic  matter  are  evolved,  and  suspended 
matter  in  the  shape  of  low  forms  of  cell-life  and  epithe- 
lium scales  is  thrown  off. 

The  effects  of  breathing  considerable  quantities  of 
carbonic  acid  in  air  otherwise  pure  have  not  yet  been 
determined  with  sufficient  accuracy.  Dr.  Angus  Smith 
has  found  that  30  volumes  per  1000  cubic  feet  of  air 
produced  great  feebleness  of  the  circulation,  slowness  of 
the  heart's  action,  aud  quickened  respiration,  but  he 
experienced  no  discomfort  in  a  soda-water  manufactory, 
where  the  amount  was  2  per  1000  volumes.  On  the 
other  hand,  Pettenkofer  and  Voit  found  that  no  discom- 
fort was  experienced  from  long  exposure  when  as  much 
4/  as  10  per  1000  volumes  was  present.  In  respired  air, 
however,  headache  and  vertigo  are  undoubtedly  produced 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  69 

in  many  persons  when  the  carbonic  acid  exceeds  1'5  per 
1000  volumes,  but  probably  this  is  as  much  due  to  the 
presence  of  organic  effluvia,  and  the  diminution  in  the 
quantity  of  oxygen,  as  to  the  increase  in  the  amount  of 
carbonic  acid.  Yet  it  must  be  borne  in  mind  that  even 
a  small  excess  of  carbonic  acid  interferes  with  healthy 
physiological  action,  inasmuch  as  it  prevents  the  sufficient 
exhalation  of  the  gas  itself,  and  induces  an  undue  accumu- 
lation of  it  in  the  blood.  In  like  manner,  the  quantity 
of  oxygen  absorbed  is  lessened,  and  there  is  consequently 
a  retardation  of  those  oxidising  processes  which  are 
requisite  for  the  complete  elimination  of  effete  matters 
from  the  system.  But  while  there  is  always  an  increase 
in  the  amount  of  carbonic  acid,  there  is  likewise,  as 
already  pointed  out,  a  marked  diminution  in  the  quantity 
of  oxygen  in  respired  air.  Thus  Dr.  Angus  Smith  found 
that  the  percentage  of  oxygen  in  the  open  air  of  a  suburb 
of  Manchester  amounted  to  20*96  ;  in  a  sitting  room,  to 
20-89  ;  in  the  pit  of  a  theatre,  to  20'74  ;  in  the  Court  of 
Queen's  Bench,  to  20'65  ;  and  in  the  sumpt  of  a  mine, 
to  20 '1400.  It  does  not  follow  that,  because  pain  or 
discomfort  is  not  always  experienced  in  a  vitiated  atmo- 
sphere, no  harm  has  been  done.  The  effects  may  be 
slowly  and  imperceptibly  cumulative,  but  they  are  none 
the  less  injurious,  and  they  are  now  recognised  as  being 
amongst  the  most  potent  and  wide-spread  of  all  the  "pre- 
disposing causes  "  of  disease. 

Speedily  fatal  results,  arising  from  overcrowding  and 
the  want  of  fresh  air,  are  familiar  to  every  student  of 
medicine.  Out  of  the  146  prisoners  confined  in  the 
"Black-Hole  of  Calcutta,"  123  died  in  one  night;  and  it 
is  significant  that  many  of  the  survivors  afterwards  suc- 
cumbed to  "  putrid  fever."  Nor  have  similar  instances 
been  wanting  in  this  country.  Of  the  150  passengers 
that  were  shut  up  in  the  cabin  of  the  Irish  steamer  Lon- 


70  AIR  :    ITS  IMPURITIES, 

donderry,  with  hatches  battened  down  during  a  stormy 
night  in  1848,  70  died  before  morning.  No  doubt,  in 
these  two  catastrophes,  the  direct  cause  of  death  was 
asphyxia,  but  the  fact  that  "  putrid  fever  "  attacked  many 
of  those  who  were  carried  out  alive  from  the  Black-Hole 
of  Calcutta  showed  that  the  foetid  exhalations  to  which 
they  were  exposed  must  have  aided  largely  in  destroying 
the  lives  of  the  immediate  victims.  Indeed,  it  is  admitted 
by  all  physiologists  that  the  re-breathing  of  foetid  matter 
thrown  off  by  the  skin  and  lungs  produces  a  kind  of 
putrescence  in  the  blood,  in  proportion  to  the  amount 
inhaled  and  to  the  period  of  exposure  to  its  influences. 
Of  this  species  of  poisoning  the  history  of  the  "  Black 
Assizes,"  in  the  sixteenth,  seventeenth,  and  eighteenth 
centuries,  furnishes  mauy  terrible  examples.  Jail,  or 
typhus,  fever,  according  to  Dr.  Murchison,  was  frequently 
generated  de  novo  solely  in  consequence  of  the  disastrous 
effects  of  overcrowding  and  deficient  ventilation,  and  the 
disease  thus  generated  often  spread  from  the  court-house, 
where  the  prisoners  were  tried,  to  the  surrounding  popu- 
lation. "My  reader,"  said  John  Howard,  "will  judge  of 
the  malignity  of  the  air  in  gaols,  when  I  assure  him  that 
my  clothes  were,  in  my  first  journeys,  so  offensive,  that  in 
a  post-chaise  I  could  not  bear  the  windows  drawn  up, 
and  was  therefore  often  obliged  to  travel  on  horseback. 
The  leaves  of  my  memorandum  book  were  often  so  tainted 
that  I  could  not  use  it  until  after  spreading  it  an  hour  or 
two  before  the  fire."  Even  so  late  as  1815,  Harty  showed 
that  typhus  was  being  constantly  generated  in  the  prisons 
of  Dublin  whenever  they  became  overcrowded  with  con- 
victs prior  to  the  periodical  transportation  of  the  accumu- 
lated numbers  to  a  penal  settlement.  Or,  to  come  to 
more  recent  times,  one  finds  Dr.  Buchanan  reporting  to 
the  medical  officer  of  the  Privy  Council  regarding  an 
extensive  epidemic  in  Merthyr-Tydfil  in  the  beginning  of 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  7l 

1870,  that  it  was  true  typhus  fever,  and  that  he  referred 
it  to  overcrowding,  and  to  want  of  ventilation  in  the 
houses  of  the  poorer  people. 

Such  are  some  of  the  more  direct  and  palpable  effects 
of  overcrowding  and  deficient  ventilation ;  but  there  are 
others,  perhaps  equally  grave,  though  not  so  well  pro- 
nounced, which  cannot  be  overlooked.  All  the  so-called 
zymotic  diseases,  for  example,  are  more  specially  fatal, 
and  spread  with  the  greatest  virulence,  in  densely  popu- 
lated and  badly  ventilated  districts,  and  it  is  in  these 
"fever-nests"  that  epidemic  diseases,  which  prevail  during 
certain  septic  conditions  of  the  atmosphere,  are  attended 
with  the  highest  mortality  and  the  greatest  sick-rate. 

Of  other  diseases  developed  by  respired  air  there  can 
be  no  question  that  phthisis  pulmonalis  holds  a  prominent  /f 
place  on  the  list.  A  large  mass  of  evidence  has  been 
collected  from  various  sources  bearing  on  this  point,  but 
the  fact  is  now  so  fully  recognised  by  the  medical  pro-  ^ 
fession  generally  that  a  few  instances  will  suffice.  In 
the  celebrated  report  of  the  Army  Sanitary  Commission, 
published  in  1858,  it  was  proved  beyond  all  doubt  that 
the  excessive  mortality  from  consumption  amongst  soldiers, 
and  in  particular  regiments,  v/as  due  to  overcrowding  and 
insufficient  ventilation.  Previous  to  that  inquiry  the 
cubic  space  per  soldier  in  the  barracks  of  the  Foot  Guards 
only  amounted  to  3  3 1  cubic  feet,  and  the  phthisis  mor- 
tality was  as  high  as  13 '8  per  1000.  In  the  Horse 
Guards,  on  the  other  hand,  with  a  space  per  man  of  572  *? 
cubic  feet,  the  mortality  from  phthisis  did  not  exceed  7 '3 
per  1000.  It  was  found  that  phthisis  prevailed  at  all 
stations,  and  in  the  most  varied  and  healthy  climates,  the 
vitiated  air  in  the  barracks  being  the  only  condition 
common  to  all  of  them.  In  consequence  of  this  excessive 
mortality,  the  Commissioners  recommended  that  the  cubic 
space  allowed  per  man  in  barracks  should  be  increased, 


"Cl  .'n++*,t    ±l-**=jUte  & 

72  AIR:    ITS  IMPURITIES, 

and  the  ventilation  improved,  with  the  result  that,  from 
the  time  their  recommendations  were  acted  upon,  the 
number  of  phthisical'  cases  occurring  at  all  these  stations 
has  materially  diminished.  Similar  evidence  is  afforded 
by  the  statistics  of  the  Eoyal  Navy,  and  notably  as 
regards  the  civil  population,  in  the  Eeport  of  the  Health 
of  Towns  Commission,  published  in  1844.  Indeed,  it  has 
been  fully  established  that  not  only  phthisis,  but  other 
lung  affections,  such  as  pneumonia  and  bronchitis,  are 
generated  to  a  large  extent  under  like  conditions,  and  the 
same  may  be  said  of  such  diseases  as  scrofula,  and  others 
of  an  adynamic  type. 

When  air  is  vitiated  by  the  exhalations  of  the  sick, 
as  in  hospitals,  there  is  a  risk  of  gangrene  and  erysipelas 
spreading,  especially  in  the  surgical  wards.  The  period  of 
convalescence  in  many  cases  is  retarded,  and  the  mortality 
rate  increased.  Pus -cells  and  putrefying  particles  are 
thrown  off  from  purulent  discharges,  and,  finding  a  suit- 
able nidus  elsewhere,  may  communicate  a  special  disease, 
and  thus  act  as  a  true  contagium.  The  prevalence  of 
purulent  ophthalmia,  under  certain  conditions,  and  the 
spread  of  lung-disease  in  badly-ventilated  ships,  when  the 
disease  appeared  to  be  propagated  from  person  to  person, 
can  only  be  fully  explained  on  some  such  theory  as  this. 

2.  Air  rendered  impure  ly  Sewage  and  Cesspool  Effluvia. 
— Amongst  the  gases  generated  by  the  decomposition  of 
faecal  matter,  whether  occurring  in  sewers  or  cesspools, 
may  be  enumerated,  carbonic  acid,  nitrogen,  sulphuretted 
hydrogen,  light  carburetted  hydrogen,  and  ammonium 
sulphide.  Dr.  Letheby  found  that  sewage-water,  excluded 
from  air,  and  containing  128  grs.  of  organic  matter  per 
gallon,  yielded  1*2  cubic  inches  of  gas  per  hour  during  a 
period  of  nine  weeks.  But  the  amount  of  gaseous  pro- 
ducts given  off  under  ordinary  circumstances  must  vary 
greatly,  according  to  the  dilution  of  the  sewage,  the 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  73 

rapidity  of  flow,  temperature,  ventilation  of  the  sewers, 
etc.  In  comparing  the  results  of  analyses  made  by 
various  chemists,  it  would  appear  that  the  oxygen  is 
diminished,  and  the  carbonic  acid  greatly  increased,  but 
that  sulphuretted  hydrogen  and  ammonium  sulphide,  when 
present,  exist  only  in  very  small  quantities.  The  pecu- 
liarly foetid  smell  of  sewage  gas  is  therefore  owing  to  the 
presence  of  organic  matter,  whose  exact  chemical  com- 
position, however,  has  not  been  determined.  Dr.  Odling 
believes  it  to  be  carbo-ammoniacal.  It  is  alkaline  in  re- 
action, and  speedily  decolourises  solutions  of  potassium 
permanganate.  According  to  Dr.  Cunningham,  it  contains 
distinct  bacteria,  and  other  low  forms  of  cell-life.  Like 
other  organic  effluvia,  it  promotes  the  growth  of  fungi, 
infects  milk,  and  taints  meat. 

It  is  doubtful  whether  the  effects  of  sewer-air  upon 
the  health  of  men  employed  at  work  in  sewers  can  be 
said  to  be  very  injurious.  Indeed,  the  researches  of 
Dr.  Guy  and  Parent  du  Chatelet,  at  first  sight,  go  to 
prove  that  this  class  of  labourers  enjoy  a  marked  im- 
munity from  diseases  which  can  be  attributed  to  sewer- 
emanations  ;  but,  as  has  been  shown  by  the  late  Dr. 
Murchison,  there  are  several  elements  of  error  in  their 
statistics  which  mar  their  conclusions.  For  example,  Dr. 
Guy's  researches  were  made  before  enteric  and  typhus 
fever  were  fully  recognised  as  distinct  diseases,  and 
Parent  du  Chatelet's  statistics  were  not  only  too  scanty 
for  a  fair  deduction,  but  the  majority  of  the  sewer-men 
whom  he  examined  had  been  employed  at  that  special 
work  for  only  a  short  period.  According  to  Dr.  Murchi- 
son's  experience,  enteric  fever  is  by  no  means  uncommon 
among  these  men,  and  Dr.  Peacock's  inquiries  led  him 
to  express  a  similar  opinion.  But  whatever  the  issue  of 
this  question,  it  seems  to  be  quite  certain  that  constant 
exposure  to  sewer-gases  diminishes  the  risk  of  being  in- 


74  AIR  :    ITS  IMPURITIES, 

jured  by  them.  A  remarkable  instance  of  this  apparent 
immunity  enjoyed  by  workmen,  and  the  disastrous  effects 
upon  those  whose  exposure  to  such  gases  was  only  casual, 
is  afforded  by  an  event  that  occurred  at  Clapham  in  the 
autumn  of  1829  : — 20  out  of  22  boys  at  the  same  school 
were  seized  with  violent  vomiting,  purging,  prostration, 
and  fever,  within  three  hours.  One  boy  had  been  seized 
with  similar  symptoms  two  days  before,  and  died ;  an- 
other also  succumbed.  So  alarming  was  the  outbreak 
that  poisoning  was  suspected,  but,  after  careful  investiga- 
tion, it  was  found  that  the  sole  cause  of  disease  was  to 
be  attributed  to  the  opening  of  a  drain  at  the  back  of  the 
house.  This  drain  had  been  choked  up  for  many  years, 
and  had  been  opened  two  days  before  the  first  illness 
occurred.  The  effluvia  from  the  drain  were  most  offen- 
sive, and  the  boys  had  watched  the  workmen  cleaning  it 
out ;  none  of  the  workmen,  however,  were  subsequently 
attacked  with  any  of  the  symptoms  which  so  seriously 
affected  the  boys. — (Murchison.) 

While  numerous  other  instances  are  recorded  of  the 
evil  effects  of  the  air  of  sewers,  cesspits,  drains,  etc.,  in 
producing  temporary  ailments,  such  as  nausea,  vomiting, 
diarrhoea,  and  headache,  the  great  interest  which  attaches 
to  this  important  subject  rests  on  the  development  and 
spread  of  enteric  fever.  Without  entering  at  present  into 
the  discu'ssion  as  to  whether  this  fever  is  purely  specific, 
or  may  be  generated  de  novo,  there  can  be  no  question 
that  the  polluted  air  from  cesspits,  drains,  and  sewers, 
becomes  the  medium  through  which  the  disease  is  fre- 
quently propagated,  if  not  engendered.  The  sewer -air, 
laden  with  morbific  ferments  or  contagia,  readily  finds  its 
way  into  houses,  more  especially  in  cold  weather,  on 
account  of  its  greater  tension,  and  in  consequence  of 
badly  trapped  or  imperfectly  ventilated  drains.  It  may 
be  inappreciable  to  the  senses,  but  its  baneful  effects 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  75 

make  themselves  felt  none  the  less,  and  frequently  exhibit 
themselves  in  houses  which  in  other  respects  are  replete 
with  every  comfort  which  wealth  can  command.  Indeed, 
it  would  appear  that  persons  of  the  upper  and  middle 
ranks  in  towns  are  more  liable  to  be  attacked  by  enteric 
fever  than  the  poorer  classes,  and  for  this  reason — the 
houses  of  the  former  are  more  generally  connected  with 
sewers,  and,  either  from  structure  or  situation,  are  of 
higher  elevation,  so  that  the  light  sewer  gases,  in  obedi- 
ence to  natural  laws,  are  more  apt  to  accumulate  in  the 
drains  of  such  houses,  and,  when  the  drains  are  not 
efficiently  trapped  or  ventilated,  to  effect  an  entrance  in  to 
the  houses  themselves.  Thus  it  happens  that  a  system 
of  sanitary  engineering,  which  is  intended  to  prevent,  and 
does  prevent,  the  development  of  disease,  not  unfre- 
quently  furnishes  the  readiest  means  for  its  propagation. 
All  this,  however,  could  be  frustrated  if  sewers  and  drains 
were  always  kept  properly  flushed  and  well  ventilated. 

Two  other  points  connected  with  the  propagation 
of  enteric  fever  deserve  notice :  (1)  it  seems  to  be  clearly 
established  that  the  disease  may  be  contracted  by  in- 
haling the  effluvia,  from  enteric  stools  previous  to  their 
being  disposed  of;  and  (2),  that  if  these  stools  be  thrown 
into  a  common  privy,  the  disease  is  almost  certain  to  be 
conveyed  to  others  who  frequent  the  privy ;  hence  the 
necessity  of  disinfecting  all  discharges  from  the  patient  so 
soon  as  they  are  passed.  (For  further  remarks  on  this 
subject,  see  Chap.  XIV.) 

Amongst  other  serious  consequences  of  faecal  emana- 
tions, the  occasional  spread  of  cholera,  and  the  occurrence 
of  autumnal  diarrhoea,  are  specially  to  be  noted.  The 
outbreak  of  cholera  in  the  City  of  London  Workhouse,  in 
July  1866,  was  shown  by  Mr.  Radcliffe  (Ninth  Report  of 
Medical  Officer  of  the  Privy  Council)  to  have  taken  place, 
in  all  probability,  in  consequence  of  a  sudden  efflux  of 


76  AIR:    ITS  IMPURITIES, 

sewer-air  from  a  drain  containing  choleraic  evacuations. 
Autumnal  diarrhoea,  again,  is  found  to  prevail  when'  the 
season  is  warm  and  dry,  and  more  particularly  in  badly- 
sewered  districts.  In  speaking  of  this  subject,  Dr. 
Murchison  says,  that  "  circumscribed  autumnal  epidemics 
of  enteric  fever  are  often  preceded  by  an  increase  of 
diarrhoea,  and  the  diarrhoea  reaches  its  acme  long  before 
the  fever  does."  After  heavy  falls  of  rain  the  sewers 
become  well  flushed,  and  the  diarrhoea  subsides.  In 
country  districts  isolated  outbreaks  of  diphtheria,  trace- 
able to  cesspool  effluvia,  are  not  at  all  uncommon.  In 
these  cases  it  is  generally  found  that  there  is  a  water- 
closet  in  the  house  which  itself  is  badly  ventilated,  that 
the  soil-pipe  is  never  ventilated,  and  that  the  closet  drain 
discharges  into  a  cesspool  which  is  completely  covered  up, 
and  only  cleaned  out  at  rare  intervals.  The  consequence 
is  that  any  gases  generated  in  the  cesspool  have  no  outlet 
except  through  the  water-closet  and  into  the  house,  and 
hence  result  attacks  of  diphtheria,  ulcerated  sore  throat, 
and  other  badly  defined  ailments. 

According  to  the  evidence  of  Sir  Henry  de  la  Beche 
and  Sir  Lyon  Playfair,  in  the  Second  Eeport  of  the  Health 
of  Towns  Commission,  there  are  strong  presumptive  grounds 
for  believing  that  emanations  from  streams  polluted  by 
faecal  matter  may  be  injurious  to  the  health  of  inhabitants 
living  on  their  banks.  It  is  stated  that  many  of  them 
were  pale,  and  suffered  from  dyspepsia,  and  that  cases  of 
fever,  when  they  occurred,  were  increased  in  severity. 
In  other  instances,  however,  no  such  effects  have  been 
traced. 

When  sewage  matter  is  thrown  over  the  ground,  the 
exhalations  given  off  have  likewise  been  proved  to  be 
sometimes  productive  of  serious  disease.  Thus,  Dr. 
Clouston  has  recorded  an  outbreak  of  dysentery  among 
the  patients  in  the  Cumberland  "and  Westmoreland  Asylum, 


AND  THEIK  EFFECTS  ON  PUBLIC  HEALTH. 

which  he  attributed  to  the  emanations  from  sewage  applied 
to  the  land  about  300  yards  from  the  asylum.  After 
this  outbreak  the  sewage  was  allowed  to  fall  into  a  small 
stream,  and  for  two  years  the  asylum  had  been  free  from 
the  disease.  At  the  end  of  this  period,  however,  the 
sewage  was  again  applied  to  the  farm,  and  again  the 
dysentery  appeared,  although  all  proper  precautions  were 
taken  in  the  way  of  disinfecting  and  in  applying  the 
sewage.  It  is  to  be  noted  that  there  was  a  stiff  brick- 
clay  subsoil,  and  doubtless  this  prevented  the  sufficient 
percolation  of  the  sewage  into  the  ground. 

3.  Effluvia  from  decomposing  Animal  Matter. — Under 
this  heading  may  be  included — the  effluvia  from  decom- 
posing carcases ;  the  air  of  graveyards ;  and  the  effluvia 
from  manure,  tallow,  and  bone- burning  manufactories. 

On  almost  all  these  points  the  evidence  is  very  con- 
flicting. The  preponderance  of  opinion,  however,  leaves 
no  room  for  doubt  that  the  effects  of  all  such  effluvia  upon 
the  health  of  the  general  population,  when  exposed  to  their 
influence,  are  more  or  less  injurious ;  and  in  support  of 
this  view  the  following  amongst  many  other  confirmatory 
instances  may  be  quoted  : — 

(1.)  The  effluvia  arising  from  the  putrid  remains  of 
horses  killed  on  the  field  of  battle  have  frequently  given 
rise  to  outbreaks  of  diarrhoea  and  dysentery  amongst  the 
soldiers.  In  the  French  camp,  before  Sebastopol,  when 
numbers  of  the  bodies  of  horses  lay  putrefying  and  un- 
buried,  the  effects  were  so  serious  that  the  spread  of 
typhus  was  supposed  to  be  due  to  this  cause. — (Parkes.) 

(2.)  According  to  the  evidence  summed  up  in  the 
Eeport  on  Extramural  Sepulture  in  1850,  the  vapours 
given  off  from  thickly  crowded  graveyards,  if  not  actually 
productive  of  disease,  do  certainly  increase  the  sick  and 
death  rate  of  the  immediate  neighbourhood. 

(3.)  Although  the  health  of  workmen  employed  in 


78  AIR:    ITS  IMPURITIES, 

manure  and  similar  manufactories  does  not  appear  to  be 
injured  by  their  occupation,  the  occasionally  disastrous 
effects  upon  others,  of  the  effluvia  given  off,  are  well 
illustrated  by  the  following  case  : — In  1847,  many  of  the 
inmates  of  Christ  Church  Workhouse,  Spitalfields,  were 
seized  with  violent  attacks  of  diarrhoea,  of  an  enteric 
type.  It  was  found  that  whenever  the  works  were  actively 
carried  on,  and  particularly  when  the  wind  blew  from 
that  quarter,  there  ensued  an  outbreak  of  diarrhoea  in  the 
workhouse.  In  December  of  the  following  year,  when 
cholera  was  spreading  in  the  neighbourhood,  sixty  of  the 
children  were  attacked  one  morning  with  violent  diarrhoea. 
In  consequence  of  this  outbreak  the  owner  of  the  manu- 
factory was  obliged  to  stop  work,  and  the  children  rapidly 
recovered.  Five  months  afterwards  the  works  were  re- 
sumed, and  again  there  was  a  similar  outbreak  amongst 
the  inmates  occupying  the  part  of  the  building  opposite 
the  manufactory.  The  works  were  once  more  discontinued, 
and  the  diarrhoea  ceased. — (Carpenter?) 

The  effluvia  produced  in  tallow-making  and  similar 
trades,  though  sometimes  very  offensive,  and  therefore  an 
undoubted  nuisance  in  inhabited  districts,  do  not  appear 
to  have  produced  any  serious  effects  which  have  been 
recorded.  According  to  Dr.  Ballard,  however,  they  often 
induce  headache,  nausea,  and  sometimes  diarrhoea. — 
(Report  of  Med.  Officer,  Local  Government  Board,  1876.) 

4.  Gases  and  Vapours  given  off  by  Alkali  Works, 
Chemical  Works,  and  Brickfields. — (1.)  The  principal  gas 
evolved  in  alkali  works  is  hydrochloric  acid.  Its  effects 
on  vegetation  are  very  destructive,  but  with  proper  care 
in  the  condensation  of  the  gas,  there  does  not  appear  to 
be  any  evidence  to  show  that  works  of  this  description 
are  injurious  to  the  health  of  those  living  in  the  neigh- 
bourhood. 

(2.)  From  chemical  works,  and  especially  from  those 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  79 

in  which  gas  liquor  is  utilised  for  the  production  of  salts 
of  ammonia  and  other  chemical  compounds,  the  injurious 
gases  evolved  consist  chiefly  of  sulphuretted  hydrogen, 
ammonium  sulphide,  and  traces  of  other  ammonium  com- 
pounds. The  workmen  -employed  at  such  works  appa- 
rently enjoy  good  health,  but  when  the  noxious  vapours 
are  not  properly  consumed  by  being  collected  and  passed 
through  a  furnace,  there  is  no  doubt  that  they  do  affect 
the  health  of  the  neighbouring  inhabitants,  though  not  to 
any  serious  extent. 

(3.)  The  peculiarly  pungent  odour  of  brickfields  can 
be  felt  at  several  hundred  yards'  distance ;  but  though 
several  cases  are  recorded,  in  which  the  existence  of  a 
nuisance  was  fully  established,  none  are  quoted  as  having 
proved  that  the  health  of  the  neighbourhood  was  affected. 

5.  The  Air  of  Marshes. — This  generally  contains  an 
excess  of  carbonic  acid,  light  carburetted  hydrogen,  watery 
vapour,  sulphuretted  hydrogen,  and  organic  effluvia.  It 
also  abounds  with  the  debris  of  vegetable  matter,  infusoriae, 
and  insects. 

The  more  serious  and  characteristic  effects  of  marsh 
miasmata  are  intermittent  and  remittent  fevers.  Ail- 
ments, however,  of  a  less  severe  nature — such  as  diarrhoea, 
dysentery,  and  various  other  gastric  derangements — have 
been  attributed  to  their  influence ;  and  even  when  no 
marked  signs  of  disease  can  be  detected,  the  inhabitants 
of  such  districts  often  present  an  enfeebled  and  pallid 
appearance.  The  submerging  of  meadows,  draining  of 
lakes,  and  digging  of  canals,  have  all  of  them  been  fol- 
lowed by  the  development  of  marsh-diseases,  probably  on 
account  of  the  decomposition  of  vegetable  matter  which 
ensues.  For  the  same  reason,  a  long  continuance  of  dry 
weather,  followed  by  rains,  favours  the  evolution  of  mias- 
mata. Fortunately,  in  this  country,  marsh-diseases  have 
become  comparatively  rare,  though  there  is  no  doubt  that 


80  AIR:    ITS  IMPURITIES, 

in  low -lying  and  badly -drained  districts  the  excessive 
sick-rate  which  often  prevails  is  in  a  great  measure  owing 
to  atmospheric  impurities  of  a  marshy  nature. 

6.  Air -Impurities  in  certain  Trades  and  Occupations. 
— The  deleterious  impurities  under  this  heading  consist 
chiefly  of  mineral  and  organic  substances,  as,  for  example, 
the  particles  of  coal-dust  in  the  air  of  mines  ;  particles  of 
steel  and  grit  given  off  in  grinding ;  arsenical  fumes,  in 
copper-smelting ;  zinc  fumes,  in  brassfounding  ;  pearl-dust, 
in  button-making ;  organic  dust  or  fluff,  in  shoddy  and 
flax  mills,  etc.  But  the  whole  of  this  part  of  the  subject 
is  so  extensive  that  only  a  few  instances  of  the  increased 
sick-rate  and  mortality  produced  by  these  impurities  can 
be  given  here. 

The  habitual  inhalation  of  coal-dust  contained  in  the 
air  of  coal-mines  results  in  what  is  called  the  "  black- 
lung  ; "  the  pneumonic  cells  becoming  gradually  blocked 
up,  so  that,  after  death,  the  lung  presents  a  peculiarly 
melanotic  appearance.  Cases  of  emphysema  and  chronic 
bronchitis  are  also  very  common  amongst  colliers,  and  it 
has  been  ascertained  that  the  aggregate  amount  of  sick- 
ness experienced  by  this  class  of  workmen  between  the 
ages  of  20  and  60  amounts  to  95  weeks,  or  67  per  cent 
more  than  the  general  average. — ( Wynter.)  No  doubt 
much  of  the  disease  with  which  miners  are  liable  to  be 
attacked  is  to  be  attributed  to  the  baneful  effects  of  in- 
haling the  products  of  combustion  given  off  by  candles, 
lamps,  etc. ;  because,  when  mines  are  well  ventilated,  as 
in  Durham  and  Northumberland,  lung  affections  are  much 
less  frequent. 

But  of  all  unhealthy  occupations  that  of  steel-grinders 
is  perhaps  the  most  fatal.  Steel-grinding  is  divided  into 
dry,  wet,  and  mixed ;  the  injurious  effects  varying  accord- 
ing to  the  amount  of  water  used  on  the  stone.  Forks, 
needles,  backs  of  scissors,  etc.,  are  all  ground  on  the  dry 


AND  THEIR  EFFECTS  OX  PUBLIC  HEALTH.  81 

stone,  and,  accordingly,  the  men  and  boys  employed  at 
this  kind  of  work  suffer  most.  The  late  Dr.  Hall  of 
Sheffield  collected  a  large  amount  of  information  bearing 
upon  this  subject,  from  which  the  following  particulars 
relating  to  the  average  duration  of  life  of  artisans  in  steel 
have  been  summarised.  Dry-grinders  of  forks,  2  9  years  ; 
razors,  3 1  years  ;  scissors,  3  2  years  ;  edge-tool  and  wool- 
shears,  3  2  years  ;  spring-knives,  3  5  years ;  files,  3  5  years  ; 
saws,  38  years;  sickles,  38  years.  Fans,  however,  are 
now  more  commonly  used  than  formerly,  while  wet- 
grinding  is  becoming  more  general,  and  as  a  result  of 
these  and  other  precautionary  means  the  average  longevity 
of  Sheffield  grinders  is  increasing. 

In  the  pottery  trade,  the  flat-pressers  and  scourers 
suffer  to  such  an  extent  from  the  effects  of  the  fine  dust 
inhaled,  that,  according  to  Dr.  Greenhow,  almost  all  of 
them  become  eventually  asthmatical. 

Pearl-button  makers,  and  workers  in  flax  or  shoddy 
mills,  are  all  afflicted  more  or  less  with  bronchial  irrita- 
tion, and  many  of  them  with  decided  lung -disease. 
Cotton-weavers  also  suffer  very  much  from  the  fine  dust 
given  off  by  the  "  sizing ; "  and  some  time  ago  an  inquiry 
was  made  by  Dr.  Buchanan  at  Todmorden,  which  revealed 
the  great  prevalency  of  lung-disease,  dyspepsia,  and  per- 
manent epistaxis,  amongst  this  class  of  operatives. 

Amongst  wool-sorters  the  disease  known  as  anthrax,  or 
malignant  pustule,  has  at  times  proved  very  fatal,  the  poison 
being  conveyed  into  the  system  generally  by  inhalation 
of  the  fine  dust  given  off  in  cleaning  the  wool,  though  it 
also  may  be  conveyed  by  local  inoculation.  Two  out- 
breaks have  recently  been  investigated — one  by  Dr.  Kussell, 
Medical  Officer  of  Health  for  Glasgow;  and  the  other, 
which  occurred  at  Bradford,  by  Dr.  Spear,  Local  Govern- 
ment Inspector. — (See  Supplements  to  Local  Government 
Reports  for  1878  and  1880.) 

G 


&M£U  * 

82  AIR:   ITS  IMPURITIES,  **4-*~ 

In  addition  to  asthma  and  bronchitis,  brassfounders 
are  very  liable  to  attacks  of  an  affection  called  "  brass- 
founders'  ague,"  the  characteristic  symptoms  of  which 
present  themselves  in  the  following  sequence  : — shivering, 
nervous  depression,  marked  febrile  disturbance,  and  pro- 
fuse sweating.  Flour-millers,  sweeps,  and  snuff-grinders, 
are  all  of  them  apt  to  suffer  from  various  forms  of  asthma. 

Workers  in  lead  are  apt  to  suffer  from  "  drooping 
wrist"  and  lead  colic;  lucifer-match  makers,  from  necrosis 
of  the  lower  jaw,  caused  by  phosphorus  fumes ;  and 
workers  in  mercury,  from  mercurialism. 

In  the  Third  Eeport  of  the  Medical  Officer  of  the 
Privy  Council,  Dr.  Greenhow  gives  the  following  sum- 
mary of  his  inquiry  into  the  excessive  mortality  from 
lung- diseases  : — 

"This  inquiry  has  demonstrated  that  an  excessive 
prevalence  of  pulmonary  diseases  is  associated  with  a 
great  variety  of  conditions,  some  of  which  must  clearly 
be  regarded  as  exciting  causes  of  these  diseases.  With 
respect  to  others,  it  has  been  found  impossible  to  obtain 
accurate  and  conclusive  evidence  that  they  produce  dis- 
eases of  the  lungs,  but  there  are  strong  grounds  for  sup- 
posing such  to  be  the  case.  There  is  also  a  third  class 
•  <  of  conditions,  on  which  great  stress  was  laid  by  various 
medical  practitioners,  and  which  may  perhaps  be  regarded 
as  having  a  tendency  to  'produce  these  diseases.  The 
conclusions  deducible  from  the  inquiry  may  therefore  be 
arranged  under  the  three  following  heads : — 
V,flT^  "  A.  Conditions  which  this  inquiry  has  shown  to  be 
direct  causes  of  pulmonary  diseases. 

"  B.  Conditions  so  frequently  associated  with  an 
excessive  pressure  of  pulmonary  diseases  that  they  may 
be  regarded  as  at  least  indirect  causes  of  these  diseases. 

"  C.   Conditions  which,  in  all  probability,  co-operate 
producing  pulmonary  diseases,  but  respecting  the  in- 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  83 

fluence  of  which  no  conclusive  evidence  could  be 
obtained." 

"A.  1.  Inhaling  an  atmosphere  loaded  with  mechan- 
ical impurities,  such  as  fine  dust  of  metal,  stone,  clay, 
or  of  certain  animal  and  vegetable  [products ;  soot,  and 
particles  of  flax,  cotton  or  woollen  fibre,  exemplified  in 
the  case  of  grinders  of  cutlery,  needles,  and  other  steel 
articles ;  miners,  quarrymen,  stonemasons,  china-scourers, 
potters,  turners  of  earthenware,  makers  of  plaster-of-Paris 
moulds,  hacklers  of  flax  and  "Mexican  fibre;  sorters  of 
wool,  alpaca,  and  mohair ;  operatives  employed  in  the 
manufacture  of  waste  silk,  and  in  the  carding-rooms  of 
cotton  factories ;  wool-combers ;  workers  in  bone,  ivory, 
horn,  and  mother-of-pearl ;  and  makers  of  walking-sticks, 
and  wooden  handles  for  cutlery,  umbrellas,  and  parasols. 

"  2.  Inhaling  an  atmosphere  containing  carbonic  acid 
or  other  gases  unfit  for  respiration,  or  fumes  arising  from 
the  combustion  of  gunpowder,  or  of  charcoal,  or  other  fuel, 
exemplified  in  the  cases  of  miners  and  wool-combers. 

"  3.  Inhaling  an  overheated  and  highly-dried  atmo- 
sphere, exemplified  in  the  cases  of  the  flat-pressers,  and 
some  other  workers  in  potteries. 

"  B.  1 .  Habitual  exposure,  during  the  hours  of  labour, 
to  a  hot  and  exceedingly  moist  atmosphere,  exemplified 
in  the  cases  of  slip-makers  in  potteries  and  spinners  of 
flax. 

"  2.  Working  in  ill- ventilated  and  over-heated  fac- 
tory-rooms, as  in  many  manufactories  of  textile  fabrics, 
in  some  of  the  decorators'  rooms  of  potteries,  in  ware- 
houses, and  likewise  in  many  establishments  where  young 
females  are  congregated  together  at  work. 

"  3.  Exposure  to  vicissitudes  of  temperature,  exem- 
plified in  the  cases  of  the  operatives  in  several  kinds  of 
factories  and  workshops. 

"  4.  A    stooping    or    otherwise    constrained    posture 


84  AIR  :    ITS  IMPURITIES, 

while  at  work,  exemplified  in  lace-makers,  throwers  of 
earthenware,  certain  classes  of  weavers,  file-cutters,  and 
silk-piercers. 

"  5.  Working  continuously  many  hours  daily  at  a 
sedentary  occupation,  such  as  that  of  the  glove- makers  of 
Yeovil,  decorators  of  earthenware,  and  welters  and  finishers 
of  hosiery. 

"6.  Working  in  ill -ventilated  and  overcrowded 
rooms,  as  in  the  straw-plat  and  lace  schools  of  Berkham- 
stead,  Towcester,  and  Newport  Pagnell,  the  winding- 
rooms  of  Leek,  and  the  weaving-shops  of  Hinckley  and 
Leicester. 

"  7.  Eesiding  in  dwellings  so  constructed  that  the 
bedrooms  are  badly  ventilated,  and  the  cubical  space  per 
head  is  inadequate  to  the  preservation  of  health,  such  as 
are  to  be  found  in  Berkhamstead  and  Saffron  Walden. 

"  C.  1.  Bleakness  of  climate,  a  cold  damp  soil,  pre- 
valence of  fogs. 

"  2.  Marriages  of  consanguinity. 

"  3.  Habitual  abuse  of  alcoholic  stimulants. 

"  4.  Insufficiency  of  animal  food." 

Although  certain  parts  of  this  summary  have  no 
immediate  connection  with  the  subject-matter  in  hand,  it 
ha,s  been  given  in  extenso,  to  show  how  frequently  several 
causes  of  disease  co-operate  in  producing  the  same  patho- 
logical results,  and  how  difficult  it  is  to  apportion  to  these 
causes  their  relative  share  in  the  combined  effects.  But, 
apart  altogether  from  the  unwholesome  influences  attach- 
ing to  particular  employments,  the  one  great  fact  which 
stands  forth  with  special  prominence  throughout  the 
whole  of  Dr  Greenhow's  inquiry  (see  also  Fourth  Report 
to  Privy  Council)  is  the  fatally  defective  state  of  the 
ventilation,  alike  of  cottage,  workroom,  and  of  busy 
factory.  The  mortality  from  lung-disease  amongst  male 
and  female  operatives  was  found  to  be  from  three  to  six 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  85 

times  as  great  as  in  other  districts  in  England ;  and  in  a 
very  large  proportion  of  cases  the  want  of  ventilation  in 
dwelling-places,  as  well  as  work-places,  prevailed  to  such 
an  extent,  that  tubercular  and  scrofulous  diseases  must 
have  resulted  abundantly  from  this  cause  alone. 

The  medical  officer  of  the  Privy  Council,  in  comment- 
ing on  this  inquiry,  remarks — "  One  must  remember  that, 
in  most  cases,  either  the  artisan's  ill-ventilated  work- 
place is  also  his  ill-ventilated  dwelling-place,  or  else  the 
dwelling-place  to  which  he  goes  for  his  rest  is  as  ill- 
ventilated  as  the  work-place  which  he  leaves  ;  that  during 
a  great  part  of  the  year  the  work-place  has  artificial  light 
in  it,  in  many  cases  gaslight  for  some  hours  of  the  day, 
and  in  some  cases  has  its  atmosphere  vitiated  by  other 
products  of  combustion ;  that  in  factories  during  winter 
the  commonly  adopted  method  of  warming  is  one  which 
in  itself  makes  the  air  unpleasant,  if  not  hurtful  for  breath- 
ing ;  and  that  in  many  branches  of  industry  good  ventila- 
tion is  essential  as  a  safeguard  against  evils  which  are 
special  to  the  employment — essential  for  the  removal  of 
injurious  dust,  or  for  the  abatement  of  an  oppressive 
temperature." 

In  all  these  industrial  employments  it  thus  appears 
that  the  sick-rate  and  death-rate  could  both  be  very 
materially  lessened  by  promoting  ventilation,  and  by  in- 
troducing some  suitable  appliances  calculated  to  protect 
the  workmen  from  the  inhalation  of  fine  dust  or  noxious 
fumes.  But  it  was  found  that  the  workmen  themselves 
often  objected  to  any  innovation  which  appeared  to  them 
to  interfere  with  their  more  immediate  comfort;  and  not  a 
few  of  them  were  under  the  impression  that  the  introduc- 
tion of  any  measures  tending  to  prolong  life  would  be  fol- 
lowed by  such  an  overstocking  of  the  labour  market  that 
the  difficulties  of  procuring  a  living  would  be  greatly 
increased.  That  such  short-sightedness  will  continue  to 


86  AIR:    ITS  IMPURITIES, 

exist  amongst  certain  numbers  of  the  artisan  class  is  only 
what  may  be  expected.  Disease  sets  in  so  insidiously 
and  progresses  so  slowly,  the  stock  of  health  to  start  with 
seems  so  ample,  and  the  individual  prospect  of  death  so 
remote,  that  sanitary  rights  are  neglected  and  the  wrongs 
quietly  endured.  No  doubt,  these  wide-spread  evils  have 
been  greatly  mitigated  of  late  years  under  the  provisions 
of  the  Factory  and  Workshops  Acts,  but  complaints  are 
still  made  by  inspectors  that  the  workmen  continue  to  be 
very  careless  about  ventilation,  and  that  they  have  a 
great  aversion  to  using  respirators,  even  when  they  know 
that  their  use  is  a  safeguard  against  disease. 

In  Germany  the  whole  of  this  subject  has  been  very 
carefully  studied  by  Dr.  Hirt,  to  whose  elaborate  work, 
Die  Krarikheiten  der  Arbeiter,  I  would  refer  all  who  are 
desirous  of  making  themselves  fully  acquainted  with  in- 
jurious trades  and  the  diseases  which  they  severally 
induce,  or  are  liable  to  induce,  in  those  employed  at  them. 

With  respect  to  the  effects  of  trade-nuisances  on  the 
general  health  of  the  community,  a  very  important  inquiry 
has  recently  been  conducted  by  Dr.  Ballard  in  behalf  of 
the  Local  Government  Board,  which  is  of  special  interest 
to  sanitary  authorities  and  their  officers  throughout  the 
country.  Dr.  Ballard's  reports  were  published  in  the  Sup- 
plements to  the  Local  Government  Board  Eeports  for  1876, 
1877,  and  1878,  and  certainly  rank  as  the  most  valuable 
and  exhaustive  contributions  which  have  hitherto  appeared 
on  the  subject.  The  trades  embraced  in  the  inquiry  in- 
cluded— (1),  the  keeping  of  animals;  (2),  the  slaughter- 
ing of  animals ;  (3),  branches  of  industry  in  which  animal 
substances  are  principally  dealt  with  ;  (4),  trades  in  which 
vegetable  matters  are  principally  dealt  with  ;  (5),  trades 
in  which  mineral  substances  are  principally  dealt  with ; 
and  (6),  trades  in  which  matters  of  mixed  origin  are  dealt 
with.  According  to  Dr.  Ballard,  the  most  offensive  effluvia 


AND  THEIR  EFFECTS  ON  PUBLIC  HEALTH.  87 

are  those  given  off  from  trade  processes,  in  which  the 
materials  used  consist  of  animal  substances — such  as  gut 
scraping,  manure  manufacturing,  and  the  melting  of  some 
kinds  of  fat.     The  industries  which  deal  with  vegetable 
substances,  though  often  very  offensive,  do  not  appear  to 
give  rise  to  effluvia  which  may  be  designated  disgusting, 
and  are   therefore   not  so  liable   to  be  injurious ;  while 
those  which  treat  mineral  substances  are  chiefly  offensive 
owing  to  the  irritant  gases  and  other  effluvia  which  are 
given  off.     As  might  be  expected,  great  difficulty  was  ex- 
perienced in  ascertaining,  with  any  approach  to  precision, 
in  what  respect,  and  to  what  extent,  these  effluvia  are 
injurious  to  health ;  but  as  regards  all  of  them,  it  has  to 
be  noted  that  in  records  of  proceedings  of  courts  of  law, 
and  as  the  result  of  Dr.  Ballard's  inquiries,  the  particular 
group  of  symptoms  generally  complained  of  consisted  of 
"  loss  of  appetite,  nausea,  sometimes  actual  vomiting,  some- 
times diarrhoea,  headache,  giddiness,  faintness,  and  a  gene- 
ral sense  of  depression  and  malaise!'      Concerning  effects 
of   a  more  definite  nature,  Dr.  Ballard  points  out  that 
while  trade  effluvia  generally  contribute  their  quota  of 
conditions  which  render  the  air  of  manufacturing  'towns 
comparatively  insalubrious,  there  are  certain  effluvia  of 
septic  origin  connected  with  businesses  of  a  specially  filthy 
nature,  which  are  undoubtedly  unwholesome,  and  give  rise 
to  filth  diseases  of  various  kinds.      Other  trades,  again,  in 
which  matters  are  dealt  with  which  are  liable  to  be  in- 
fected with  specific  contagia,  cannot  fail  to  be  dangerous 
to  persons  exposed  to  such  influence ;   while,  as  regards 
trades  which  give  off  effluvia  consisting  of  definite  chemi- 
cal  compounds,   they   are,  as  a  rule,  only  irritating  or 
injurious  in  proportion  to  their  degree  of  concentration. 
It  is  often  suggested  by  manufacturers,  that  because  certain 
effluvia  given  off  by  chemical  works  are  in  common  use 
as  disinfecting  agents,  they  must  actually  be  beneficial  to 


88       THE  EFFECTS  OF  IMPURE  AIR  ON  PUBLIC  HEALTH. 

public  health ;  but,  as  Dr.  Ballard  points  out,  this  argu- 
ment is  altogether  fallacious,  inasmuch  as  such  agents  are 
virtually  inoperative,  unless  applied  in  a  degree  of  con- 
centration far  greater  than  the  diluted  effluvia  often 
complained  of  outside  the  works. 

In  other  respects,  Dr.  Ballard's  reports  are  especially 
valuable,  because  they  point  out  in  detail  not  only  the 
trades  or  trade  processes  which  are  most  complained  of  as 
offensive,  but  they  explain  the  methods  in  use,  or  which 
may  be  devised,  for  preventing  or  minimising  the  nuisances 
arising  from  them.  This  part  of  the  subject,  however, 
will  be  more  fully  treated  in  Chap.  XVI. 


VENTILATION  AND  WARMING.  89 


CHAPTEE  IV. 

VENTILATION  AND  WARMING.    ' 

THESE  two  subjects  may  be  conveniently  treated  under 
the  following  sections  : — 

I.  The  Amount  of  Fresh  Air  required. 
II.  The  Necessary  Amount  of  Cubic  Space. 

III.  Natural  Ventilation. 

IV.  Artificial  Ventilation  and  Warming. 

SECTION  I. — THE  AMOUNT  OF  FRESH  AIR  REQUIRED. 

As  the  air  contained  in  an  inhabited  room  cannot, 
under  the  most  favourable  circumstances,  be  maintained 
in  as  pure  a  condition  as  the  external  air,  the  object  of 
ventilation  is  to  reduce  the  impurities  of  respiration  to 
such  an  extent  that  continued  inhalation  of  them  will  not 
be  detrimental  to  health.  While  this  can  only  be  effected 
by  a  constant  supply  of  fresh  air,  it  is  evident  that  the 
quantity  required  will  very  much  depend  on  the  amount 
of  impurities  which  may  be  allowed  to  accumulate  in 
respired  air  without  proving  injurious.  The  first  point, 
therefore,  which  has  to  be  determined  is  the  limit  of 
maximum  impurity  consistent  with  the  maintenance  of 
perfect  health.  It  has  already  been  shown  that  the 
amount  of  carbonic  acid  in  air  vitiated  by  respiration  is 
a  tolerably  reliable  index  to  the  other  impurities  ;  and 
Ijence  the  question  resolves  itself  into  this, — What  amount 


90  VENTILATION  AND  WARMING. 

of  carbonic  acid  shall  be  accepted  as  the  standard  of  per- 
missible maximum  impurity  ?  After  numerous  experi- 
ments, and  a  most  extended  inquiry,  Dr.  Parkes  has  given 
it  as  his  opinion  that,  allowing  *4  volume  as  the  average 
amount  of  carbonic  acid  in  1000  volumes  of  air,  this 
standard  ought  not  to  exceed  '6  per  1000  volumes;  be- 
cause, when  this  ratio  is  exceeded,  the  organic  impurities, 
as  a  rule,  become  perceptible  to  the  senses.  With  a  ratio 
of  *8,  *9,  or  *L  per  1000  volumes,  the  air  smells  stuffy 
and  close,  and  beyond  this  it  becomes  foul  and  offensive. 
— (Practical  Hygiene.) 

Perhaps  there  is  no  class  of  buildings  which  present 
better  opportunities  for  arriving  at  an  approximate  and 
practical  solution  of  this  problem  than  prisons ;  and  it 
may  prove  of  some  service  if  I  record  briefly  the  results 
of  some  experiments  which  some  few  years  ago  I  had  a 
share  in  conducting,  and  which  are  strongly  corroborative 
of  Dr.  Parkes'  views. — In  one  of  the  English  convict 
prisons  one-half  the  prisoners  are  kept  in  separate  con- 
finement, except  when  at  exercise  ;  the  other  half  are 
confined  in  their  cells  only  during  the  night  and  when 
at  meals.  The  cubic  space  and  ventilating  arrangements 
in  the  part  of  the  prison  occupied  by  the  former  were 
such  that  the  average  ratio  of  carbonic  acid,  after  a  series 
of  observations  made  at  different  hours  of  the  night,  was 
found  to  be  '720  per  1000  volumes;  while  in  the  part 
of  the  prison  occupied  by  the  latter  the  cubic  space  was 
much  smaller,  and  the  average  amount  of  carbonic  acid 
was  as  high  as  TO 44  per  1000  volumes.  The  same 
number  of  observations  were  made  in  both  parts  of  the 
prison  at  the  same  hours  during  the  night-time,  so  that  a 
strictly  fair  comparison  could  be  drawn.  •  Now,  a  careful 
inspection  of  the  two  classes  of  prisoners  resulted  in 
showing  that  whereas  the  former  were  well  nourished  and 
heal  thy -looking,  the  latter  presented  a  somewhat  less 


VENTILATION  AND  WARMING.  91 

robust  and  more  pallid  appearance  ;  and  after  eliminating 
every  source  of  error,  this  difference  in  appearance  could 
only  be  accounted  for  by  the  difference  in  the  amount  of 
impurities  contained  in  the  respired  air  of  both  parts  of 
the  prison. 

I  have  had  many  other  opportunities  of  examining 
into  this  point,  and  would  say,  in  general,  that  when  the 
carbonic  acid  does  not  exceed  '8  per  1000  volumes,  no 
tangible  injurious  effects  upon  the  health  can  be  detected ; 
but  when  it  reaches  1  per  1000  volumes,  the  cumulative 
effects  manifest  themselves  in  producing  a  pallid  dyspeptic 
appearance,  and  make  themselves  felt,  in  numerous  in- 
stances, in  general  malaise  of  a  morning,  slightly  coated 
tongue,  nasty  taste  in  the  mouth,  and  headache. 

The  desirability  of  adopting  Dr.  Parkes'  estimate  as 
the  standard  of  maximum  impurity  is  also  borne  out  by 
the  observations  and  experiments  of  such  eminent  autho- 
rities as  Professor  Pettenkofer  of  Munich,  Dr.  Angus 
Smith,  and  Dr.  de  Chaumont.  "  We  all  avoid,"  says  Dr. 
Smith,  "  an  atmosphere  containing '1  per  cent  of  carbonic 
acid  in  crowded  rooms ;  and  the  experience  of  civilised 
men  is,  that  it  is  not  ouly  odious  but  unwholesome. 
When  people  speak  of  good  ventilation,  they  mean,  with- 
out knowing  it,  air  with  less  than  '07  percent  of  carbonic 
acid.  We  must  not  conclude  that  because  the  quantity 
of  carbonic  acid  is  small,  the  effect  is  small ;  the  conclu- 
sion is  rather  that  minute  changes  in  the  amount  of  this 
gas  are  indications  of  occurrences  of  the  highest  import- 
ance."— (Air  and  Rain.) 

Assuming,  then,  that  '6  carbonic  acid  per  1000 
volumes  is  accepted  as  the  standard  of  maximum  im- 
purity, the  next  question  comes  to  be— How  much  fresh 
air  must  be  supplied  per  head  per  hour,  in  order  that  the 
respired  air  should  not  contain  impurities  in  excess  of 
this  standard  ?  It  has  already  been  stated,  in  the  previous 


92  VENTILATION  AND  WAKMING. 

chapter,  that  an  adult  man  exhales  on  the  average  '6  cubic 
foot  of  carbonic  acid  per  hour,  and  taking  the  initial  car- 
bonic acid  contained  in  the  atmosphere  at  the  normal 
ratio  of  '4  per  1000  volumes,  the  quantity  of  fresh  air 
which  should  be  supplied  is  found  by  calculation  to 
amount  to  3000  cubic  feet  per  head  per  hour,  in  all  cases 
in  which  the  diffusion  of  the  contained  air  is  uniform.  Of 
course,  if  a  standard  not  so  pure  is  fixed  upon,  the  amount 
of  fresh  air  required  would  be  proportionately  less.  Thus, 
supposing  the  limit  of  maximum  impurity  to  be  *7  car- 
bonic acid  per  1000  volumes,  the  amount  required  would 
be  2000  cubic  feet;  if  '8,  1500  cubic  feet;  and  '9,  it 
would  be  1200  cubic  feet  per  head  per  hour.  It  is 
evident  also  that  women  and  children  would  require  a 
smaller  supply  than  men,  because  they  do  not  vitiate 
the  air  so  rapidly. 

The  results  obtained  by  actual  experiment  accord  so 
closely  with  those  which  have  been  deduced  from  mathe- 
matical calculation  that  some  of  them  may  be  fitly  quoted 
here.  The  following  are  given  by  Dr.  de  Chaumont 
(Edin.  Med.  Journal,  1867)  as  selections  from  a  series  of 
observations  made  at  Aldershot  camp : — In  a  room  con- 
taining 18  men,  with  a  supply  of  1200  cubic  feet  of 
fresh  air  per  head  per  hour,  the  carbonic  acid  was  found 
to  be  '855  per  1000  volumes;  in  another  containing  13 
men,  with  a  supply  of  about  1700  cubic  feet,  it  was  '759 
per  1000  volumes ;  and  in  a  third,  containing  2  2  men, 
and  with  a  supply  of  about  765  cubic  feet  per  head  per 
hour,  it  amounted  to  1*2  per  1000  volumes.  All  these 
observations  were  made  at  the  same  hour  (5  A.M.),  and  in 
barrack -rooms  ventilated  on  the  plan  proposed  by  the 
Barrack  Commissioners  in  1861,  which  provided  that  at 
least  1200  cubic  feet  of  fresh  air  should  be  delivered  per 
head  per  hour. 

But   there   are  other  circumstances   in  which   it   is 


VENTILATION  AND  WARMING.  93 

necessary  to  augment  the  delivery  of  fresh  air  in  order  to 
maintain  the  standard  of  purity.  When  lights  are  used, 
for  example,  and  the  products  of  combustion  are  allowed 
to  pass  into  a  room,  a  large  supply  is  required  to  keep 
the  contained  air  sufficiently  diluted.  Thus  it  is  found 
that  1  cubic  foot  of  coal  gas  destroys  the  oxygen  of  8 
cubic  feet  of  air  in  combustion,  and  produces  about  2 
cubic  feet  of  carbonic  acid,  besides  other  impurities.  As 
a  common  gas-burner  burns  about  3  cubic  feet  of  gas  per 
hour,  the  importance  of  having  these  deleterious  products 
of  combustion  carried  off  by  special  channels  will  be 
readily  admitted. 

It  is  evident  also  that  the  sick  require  a  larger  supply 
of  fresh  air  than  the  healthy,  for  it  has  been  found  that 
when  as  much  as  3500  to  3700  cubic  feet  have  been 
delivered  per  patient  per  hour,  hospital  wards  have  not 
been  free  from  offensive  smelL  Indeed,  no  greater  proof 
can  be  afforded  of  the  value  of  pure  air  than  the  excellent 
results'  obtained  in  surgical  cases  in  times  of  war,  and  in 
medical  cases  when  epidemics  are  raging,  by  exposing 
patients  as  much  as  possible  to  the  external  air. 

SECTION  II. — CUBIC  SPACE. 

This  should  be  large  enough  to  permit  the  passage  of 
3000  cubic  feet  of  air  per  head  per  hour,  without  pro- 
ducing perceptible  draughts.  If  the  cubic  space  per  head 
is  small,  the  renewal  of  air  will  necessarily  be  much  more 
frequent  than  when  it  is  large.  Thus,  with  a  space  of 
100  cubic  feet,  the  contained  air  must  be  renewed  thirty 
times  per  hour,  in  order  that  the  standard  amount  be  sup- 
plied ;  whereas,  with  one  of  1000  cubic  feet,  only  three 
renewals  of  air  would  be  required.  What,  then,  is  the 
minimum  amount  of  cubic  space  through  which  the  stand- 
ard amount  of  fresh  air  can  be  passed  without  perceptible 


94  VENTILATION  AND  WARMING. 

movement  ?  Professor  Pettenkofer  has  answered  this 
question  experimentally,  and  has  found  that  by  means  of 
artificial  ventilation,  and  with  the  aid  of  the  best  mechani- 
cal contrivances,  the  air  in  a  chamber  of  424  cubic  feet 
can  be  renewed  six  times  per  hour  without  creating  any 
appreciable  air-currents.  No  doubt,  therefore,  such  a  space 
as  this,  or  one  somewhat  smaller,  can  be  efficiently  ven- 
tilated, provided  that  perfect  artificial  means  be  employed, 
and  the  air  warmed,  but  with  natural  ventilation  this 
becomes  impossible.  Indeed,  a  change  of  air  three  or  four 
times  per  hour  is  all  that  can  be  borne  in  this  country 
without  discomfort,  and  this  would  require  an  initial  air- 
space of  750  to  1000  cubic  feet.  Practically  speaking, 
the  difficulties  of  ventilating  small  spaces  efficiently  are 
due  not  so  much  to  the  movement  of  the  contained  air  as 
to  the  relative  position  of  the  inlets,  these  being  of  neces- 
sity so  near  the  person  that  the  draughts  which  are  pro- 
duced become  disagreeable  or  injurious.  This  is  well 
exemplified  in  the  case  of  prisons.  In  hard-labour  prisons, 
where  convicts  are  confined  in  their  cells  only  during  the 
hours  of  rest,  the  cell-space  seldom  exceeds  200  cubic 
feet.  The  consequence  is  that  in  cold  or  inclement 
weather  these  draughts  become  so  unpleasant  that  many 
of  the  prisoners  block  up  the  inlets  as  effectually  as  they 
can,  and  of  course  obstruct  the  ventilation  to  a  serious 
extent.  So  far  as  my  experience  goes,  it  is  difficult,  even 
with  the  aid  of  a  well-devised  plan  of  ventilation,  to  sup- 
ply the  necessary  amount  of  fresh  air  per  head  per  hour 
without  creating  perceptible  draughts  occasionally,  if  the 
space  be  less  than  600  cubic  feet.  I  have  further  satis- 
fied myself  that  with  the  same  artificial  appliances  and 
arrangements,  the  air  contained  in  small  occupied  spaces 
becomes  much  more  impure  than  in  large  spaces.  For 
example,  in  the  experiments  already  alluded  to  in  the  last 
chapter,  the  cell-space  in  one-half  the  prison  was  210 


VENTILATION  AND  WARMING. 


95 


cubic  feet,  in  the  other  half  it  was  614.  The  same  means 
for  extracting  the  foul  air  through  flues  leading  from 
every  cell  to  a  foul-air  extraction  shaft,  in  which  a  fur- 
nace was  kept  burning  to  produce  a  constant  draught, 
were  common  to  both  parts  of  the  building.  Moreover, 
the  fresh-air  inlets  were  more  amply  provided  for  in  the 
small  than  in  the  large  cells,  and  yet  the  average  amount 
of  carbonic  acid,  after  a  series  of  observations,  was  found 
to  be  1*044  per  1000  volumes  in  the  former,  and  only 
•720  in  the  latter. 

With  a  small  cubic  space  it  is  impossible  to  obtain 
uniform  diffusion  of  the  contained  air,  if  a  large  amount 
of  fresh  air  is  supplied,  because  between  inlet  and  outlet 
a  'direct  current  is  established,  and  a  considerable  quantity 
of  air  passes  right  through  without  being  utilised.  Again, 
it  is  evident  that  if  the  ventilation  is  impeded  or  becomes 
arrested,  impurities  will  collect  with  far  greater  rapidity 
in  a  small  than  in  a  large  space,  and  this  of  itself  is  a 
great  argument  in  favour  of  the  adoption  of  an  ample 
cubic  space  as  a  basis.  Dr.  de  Chaumont,  in  his  remarks 
on  this  point,  writes : — "  Let  us  suppose  two  occupied 
spaces,  one  of  500  and  the  other  1000  feet,  ventilated  so 
that  the  ratio  of  carbonic  acid  is  '06  per  cent,  and  that 
from  some  cause  or  other  the  ventilation  is  arrested  in 
both,  the  condition  will  then  be  as  follows : — 


"1000  feet 
"Ratio  of  impurity. 
'After  one  hour    .      -12  per  cent, 
two  hours  .      '18 
three  ,,      .      '24 
four     ,,      .      -30 
six  -42 


seven  ,, 


•48 


"500  feet 

"Ratio  of  impurity. 
After  one  hour    .     *18  per  cent, 
two  hours  .     '30 
three  ,,      .     '42 
four     „      .     -54 
six  78 


seven  „ 


•90 


With  ordinary  means  of  ventilation  (artificial  excluded) 
both  Dr.  Paikes  and  Dr.  de  Chaumont  have  contended 
that  the  cubic  space  for  a  healthy  adult  ought  at  least  to 


96  VENTILATION  AND  WARMING. 

be  1000  feet.  It  is  true  this  is  very  much  in  excess  of 
what  is  generally  obtained.  In  the  crowded  dwellings  of 
the  poorer  classes  it  seldom  exceeds  200  to  250  cubic 
feet ;  but  then  the  disastrous  effects  declare  themselves 
but  too  clearly  in  the  increased  rate  of  mortality.  In 
metropolitan  lodging-houses  the  allowance  per  head  is  as 
low  as  240  cubic  feet;  and  in  the  Dublin  registered 
lodging-houses  it  is  300.  The  Barrack  Commissioners, 
on  the  other  hand,  recommended  a  minimum  space  of  6  0  0 
cubic  feet  for  soldiers,  insisting  at  the  same  time  that  the 
air  should  be  renewed  at  least  twice  every  hour.  "  The 
only  safe  principle,"  they  said,  "  in  dealing  with  the  sub- 
ject is  to  have  a  large  margin  for  contingencies ;  and  the 
question  really  is,  not  whether  600  cubic  feet  per  man 
be  too  much,  but  whether  600  cubic  feet  per  man  be 
enough  for  all  the  purposes  of  warming,  ventilation,  and 
comfort."  Experiments  that  have  since  been  made,  and 
particularly  those  conducted  by  Dr.  de  Chaumont,  prove 
most  incontestibly  that  even  this  comparatively  large 
allowance  is  inadequate  for  these  purposes ;  but  it  was 
as  much  as  could  be  obtained  at  the  time,  without  putting 
the  country  to  enormous  expense.  The  Commissioners 
themselves  observe  : — "  It  has  been  said  that  the  question 
of  cubic  space  is  simply  a  question  of  ventilation,  but  it 
is  rather  a  question  as  to  the  possibility  of  ventilation. 
The  more  beds  or  encumbrances  you  have  in  a  room,  with 
a  limited  cubic  space,  the  more  obstruction  you  have  to 
ventilation-;  the  fewer  the  beds,  the  more  easy  is  it  to 
ventilate  the  rooms.  There  are  fewer  nooks  and  corners, 
fewer  surfaces  opposed  to  the  movement  of  the  air,  and 
less  stagnation.  We  have  been  in  rooms,  both  in  barracks 
and  hospitals,  in  which  the  atmosphere  was  positively 
offensive  with  the  doors  and  windows  open." 

For  further  remarks  on  cubic  space  in  hospitals,  see 
Chapter  on  Hospitals. 


VENTILATION  AND  WARMING.  97 

Iii  summing  up  this  part  of  the  subject,  the  following 
may  be  accepted  as  the  standard  conditions  necessary  for 
the  requirements  of  perfect  health  : — 

1.  That  the  limit  of  maximum  impurity  of  air  vitiated 
by  respiration  ought  not  to  exceed  '6  carbonic  acid  per 
1000  volumes. 

2.  That  to  ensure  the  maintenance  of  this  standard 
under  ordinary  circumstances,  3000  cubic  feet  of  pure  air 
must  be  supplied  per  head  per  hour. 

3.  That  for  this  purpose,  and  with  ordinary  means  of 
ventilation,  a  space  of  at  least  1000  cubic  feet  should  be 
allowed  per  head  in  buildings  permanently  occupied. 

It  may  be  objected  that  these  conditions  aim  at  too 
high  a  standard,  and  that  in  general  they  are  seldom  met 
with ;  but  it  must  be  remembered,  as  Dr.  de  Chaumont 
has  so  well  pointed  out,  that  they  are  based  on  a  firm 
foundation  of  facts,  and  that,  though  it  may  not  be  pos- 
sible to  prove  in  all  cases  that  bad  effects  result  from  a 
neglect  of  them,  it  does  not  follow  that  such  bad  effects 
may  not  have  been  produced.  In  a  country  like  this, 
with  a  climate  so  variable,  the  cubic  space  allowance  is  a 
most  important  element  in  any  scheme  of  ventilation.  It 
should  be  ample  enough  to  permit  of  a  sufficient  supply 
of  fresh  air  without  creating  injurious  draughts,  and 
yet  not  too  large  to  interfere  with  the  maintenance  of 
a  sufficient  and  equable  temperature  during  cold  weather. 
"Where  artificial  ventilation  is  provided,  and  when  the 
fresh  air  can  be  heated  before  entering,  it  may  be  as  low 
as  400  cubic  feet,  but  even  then  the  ventilating  arrange- 
ments must  be  much  more  perfect  than  they  usually  are. 
In  the  case  of  healthy  adults,  such  as  soldiers  and 
prisoners,  the  standard  allowance  may  also  be  consider- 
ably lessened,  if  care  be  taken  that  the  free  entrance  of 
fresh  air  at  all  hours  and  in  sufficient  quantity  shall  not 
be  interfered  with.  Unfortunately  the  question  of  cubic 

H 


98  VENTILATION  AND  WARMING. 

space  is  a  question  of  large  outlay,  and  hence  the  desire 
to  economise  tends  to  curtail  the  minimum  not  within 
safe  limits,  but  within  limits  that  will  not  be  attended 
with  glaring  injurious  effects. 

In  advocating  these  conditions,  however,  it  is  but 
right  to  state  that  the  numerous  experiments  and  weighty 
opinions  of  Dr.  Angus  Smith  are  somewhat  at  variance 
with  them.  In  the  first  place,  Dr.  Smith's  experiments 
only  give  *4  cubic  feet  of  carbonic  acid  per  hour,  which 
would  reduce  the  requisite  amount  of  fresh  air  supply  per 
hour  to  2000  cubic  feet;  and,  in  the  second  place,  Dr. 
Smith  maintains  that  uniform  diffusion  of  the  contained 
air  is  the  exception  and  not  the  rule,  and  in  fact  that  it 
does  not  occur  at  all.  With  regard  to  the  first  of  these 
points,  the  discrepancy  between  Dr.  Smith's  results  and 
those  of  other  physiologists  may  be  reconciled  on  the 
ground  that  his  trials  were  admittedly  not  made  on  large 
men ;  but  with  regard  to  the  second,  there  still  exists 
considerable  divergence  of  opinion.  If  by  uniform  diffu- 
sion throughout  an  occupied  space  is  meant  the  exact 
uniformity  of  the  chemical  composition  of  the  air  in  every 
part,  then  it  must  be  conceded  that  Dr.  Smith  is  strictly 
correct ;  for  so  long  as  fresh  air  is  entering  and  foul  air 
issuing  from  a  room,  there  will  not  only  be  a  difference 
between  the  composition  of  the  air  in  the  immediate 
proximity  of  the  inlets  and  outlets,  but  there  will  also  be 
a  difference  in  various  parts  caused  by  the  currents,  how- 
ever imperceptible  these  may  be.  In  small  occupied 
spaces,  such  as  prison  cells,  provided  with  adequate  means 
for  artificial  ventilation,  the  amount  of  fresh  air  required 
to  keep  the  carbonic  acid  from  exceeding  *6  per  1000 
volumes  must  obviously  be  much  less  than  the  amount 
required  per  head  in  a  large  room,  because  uniform  diffu- 
sion is  impossible,  there  being  a  constant  movement  of 
the  air  from  inlet  towards  outlet.  But  in  a  large  space 


VENTILATION  AND  WAKMING.        .  99 

the  case  is  different,  even  though  the  cubic  space  per  head 
be  not  greater  than  that  of  the  prison  cell.  The  entering 
currents  and  the  currents  produced  by  inequalities  of 
temperature  are,  in  this  instance,  much  more  numerous, 
and  produce  a  much  greater  mixing  of  the  air,  while  the 
impurities  given  off  by  respiration  have  greater  scope  to 
be  affected  by  the  laws  of  gaseous  diffusion.  For  all 
practical  purposes,  therefore,  the  condition  of  uniform  diffu- 
sion, as  applying  to  a  room  occupied  by  several  persons, 
may  be  accepted  as  sufficiently  accurate;  and  this  being 
so,  the  standard  amount  of  fresh  air  to  be  delivered  per 
head  per  hour  should,  as  already  stated,  be  3000  cubic 
feet.  Indeed,  the  whole  of  the  controversy  between  Dr. 
Angus  Smith,  on  the  one  hand,  and  Drs.  Parkes  and  de 
Chaumont  on  the  other,  regarding  this  point,  seems  to  be 
based  on  a  misunderstanding ;  each  party  estimated  the 
requirements  of  ventilation  for  a  single  individual,  but 
under  different  conditions — the  former  taking  it  for 
granted  that  the  space  is  occupied  by  one,  the  latter  that 
it  is  occupied  by  several. 

SECTION  III. — NATURAL  VENTILATION. 

Xatural  ventilation  is  earned  on  by  the  agency  of 
natural  forces,  such  as  gaseous  diffusion  and  movements 
of  air  produced  by  inequalities  of  temperature. 

1.  Diffusion. — The  force  of  gaseous  diffusion,  upon 
which  the  uniform  constitution  of  the  atmosphere  itself 
depends,  is  manifestly  inadequate  as  a  ventilating  power. 
It  operates  chiefly  in  producing,  as  has  been  already  stated, 
a  tolerably  equal  distribution  of  the  gaseous  products  of 
respiration  and  combustion  throughout  the  air  contained  in 
a  room,  but  aids  only  to  a  very  slight  extent  the  removal 
of  these  impurities  from  the  room,  while  it  is  altogether 
inoperative  as  regards  the  removal  of  organic  impurities. 


100  VENTILATION  AND  WARMING. 

2.  Movements  of  Air  produced  ly  Inequalities  of 
Temperature. — As  common  air  is  subject,  like  other  gases, 
to  the  laws  of  gaseous  expansion,  it  undergoes  a  certain 
increase  or  diminution  in  bulk,  according  as  it  is  heated 
or  cooled.  Warm  air  is,  therefore,  lighter  than  cold  air, 
and  hence  a  constant  interchange  goes  on  through  every 
available  opening,  whenever  there  is  any  difference  be- 
tween the  outside  and  inside  temperature.  The  contained 
air,  on  being  heated,  expands,  a  portion  of  it  escapes,  and 
the  colder  outside  air  rushes  in  to  establish  the  equilibrium. 
In  this  way  a  constant  stream  of  fresh  air  may  be  made 
to  enter  a  room  by  simply  keeping  the  inside  temperature 
higher  than  the  outside.  But  in  addition  to  the  slighter 
currents,  the  movements  of  the  external  air,  or  winds, 
greatly  assist  ventilation  by  their  perflating  or  aspirating 
action.  Perflation  is  best  exemplified  in  the  cross-venti- 
lation which  takes  place  through  opposite  windows  when 
opened.  This  is  by  far  the  readiest  means  which  can  be 
adopted  for  removing  speedily  and  effectually  aerial  im- 
purities from  a  room,  but  it  cannot  always  be  depended 
on,  on  account  of  the  uncertainty  of  the  rate  of  movement ; 
for  if  the  air  be  stagnant,  there  can  be  little  or  no  perfla- 
tion,  while,  on  the  other  hand,  if  the  rapidity  of  movement 
is  great,  perflation  becomes  insupportable  in  consequence 
of  the  draughts  produced.  A  current  of  cold  air  moving 
at  the  rate  of  five  or  six  feet  per  second  becomes  unbear- 
able. In  spite  of  this  objection,  however,  cross -ventilation 
should  always  be  provided  for  whenever  it  is  practicable, 
and  especially  in  large  rooms,  such  as  hospital  wards. 

The  aspirating  action  of  the  wind  produces  up-currents 
through  chimneys  and  air-shafts,  by  creating  a  partial 
vacuum  in  them,  which  is  constantly  being  filled  by  the 
column  of  air  from  beneath.  The  mechanical  arrange- 
ments which  have  been  proposed  or  adopted  to  facilitate 
the  action  of  these  natural  ventilating  powers  are  so 


VENTILATION  AND  WARMING.  101 

numerous  and  varied,  that  only  a  brief  mention  of  the 
more  important  of  them  can  be  given.  To  utilise  the 
perfating  force  of  the  wind,  opposite  windows  should  be 
made  to  open  from  the  top  and  bottom,  and  to  obviate  the 
unpleasantness  arising  from  draughts,  some  such  arrange- 
ments as  the  following  have  been  recommended  : — 

(1.)  By  having  the  window  so  constructed  that  the 
top^slopesjnward  when  it  is  opened,  so  that  the  entering     I ' 
current  of  air  impinges  against  the  ceiling.     If  the  win- 
dow is  large,  as  in  churches  or  schools,  only  a  section  of 
the  upper  part  may  be  made  to  open  in  this  way. 

(2.)  By  substituting  a  glass  louvre  for  the  top  centre 
pane. 

(3.)  By  having  some  of  the  panes  doubled ;  the  outer 
with  an  open  space  at  the  lower  edges ;  the  inner  with 
an  open  space  of  the  same  size  at  their  upper  edges.  The 
air  on  entering  is  thus  made  to  pass  upwards  between  the 
panes.  ll 

(4.)  By  having  some  of  the  panes  made  of  perforated 
glass,  as  in  Pott's  plan. 

(5.)  By  raising  the  lower  sash  of  the  window  two  or 
three  inches  and  filling  in  the  opening  under  the  bottom 
rail  with  a  piece  of  wood  as  proposed  by  Mr.  P.  H.  Bird. 
This  leaves  a  corresponding  space  between  the  meeting 
rails  in  the  middle  of  the  window  through  which  the  enter- 
ing current  of  fresh  air  is  directed  towards  the  ceiling. 

(6.)  By  having  a  part  of  a  pane  to  open  or  shut  at 
will  by  a  spring  arrangement,  as  in  Boyle's  ventilator. 

(*7.)  By  fixing  a  fine  wire  screen  to  the  top  of  the 
window,  which  unfolds  when  the  window  is  pulled  down, 
and  folds  up  when  the  window  is  shut.  As  the  fine 
meshes  of  the  screen  are  apt  to  become  clogged  up  with 
dust,  this  plan  is  objectionable,  except  when  the  windows 
are  of  low  elevation  as  in  attic  rooms. 

Other  outlets  and  inlets  may  be  provided  by  inserting 


102  VENTILATION  AND  WARMING. 

perforated  bricks  in  the  walls  near  the  ceiling.  One  of 
the  best  inlets  is  the  Sheringham  valve,  which  closes  at 
will  by  a  balanced  weight.  It  slopes  inwards  and  upwards 
when  open,  so  that  the  entering  current  of  air,  which  first 
passes  through  a  perforated  brick  or  grating,  is  directed 
towards  the  ceiling. 

Currall's  patent  ventilators,  supplied  by  Tonks  and 
Sons,  Birmingham,  are  easily  applied,  and  appear  to  work 
'very  well.  The  inlet  is  made  suitable  for  doors,  windows, 
and  walls,  and  is  so  arranged  as  to  obviate  disagreeable 
draughts,  while  the  outlet  may  be  inserted  in  the  chimney- 
breast  or  an  outer  wall.  Ellison's  conical  bricks,  which 
are  pierced  with  conical  holes,  are  so  constructed  as  to 
admit  outer  air  without  creating  perceptible  draught. 

In  some  cases  cross- ventilation  can  be  tolerably  well 
maintained,  independently  of  opposite  windows,  by  means 
of  transverse  ventilating  boxes  or  tubes,  situated  at  regular 
distances,  and  in  close  proximity  to  the  ceiling.  These 
boxes  or  tubes  extend  from  wall  to  wall,  and  communicate 
with  the  external  air  at  either  end  by  air-bricks.  The 
sides  are  made  of  perforated  zinc,  and  there  is  a  diaphragm 
in  the  centre  of  each,  to  prevent  the  wind  from  blowing 
right  through.  According  to  the  direction  of  the  wind, 
one-half  the  tube  becomes  an  inlet  for  fresh  air,  which 
falls  gently  into  the  room  through  the  perforated  zinc, 
while  the  other  half  becomes  an  outlet  for  the  vitiated 
air. 

This  plan  does  very  well  for  large  hospital  wards 
having  an  internal  corridor  running  along  one  side. 
Inner  rooms  can  also  be  supplied  with  a  certain  amount 
of  cross-ventilation  in  the  same  way. 

Another  plan  which  has  been  very  much  lauded 
within  the  past  few  years  is  that  which  is  associated  with 
the  name  of  Mr.  Tobin  of  Leeds.  It  consists  in  intro- 
ducing fresh  air  by  means  of  vertical  tubes  carried  for  a 


VENTILATION  AND  WARMING.  103 

rertain  distance  up  the  walls  of  the  room,  so  as  to  obviate 
any  discomfort  arising  from  down-draught.  In  rooms  or 
class-rooms  with  windows  only  on  one  side,  this  is  a  very 
convenient  method  of  improving  the  ventilation.  Another 
method  of  ventilating  by  pipes,  introduced  by  Messrs. 
Shillito  and  Shorland  of  Manchester,  has  also  been  found 
to  work  very  well. 

The  aspirating  power  of  the  wind  is  frequently  utilised 
by  placing  cowls  on  the  tops  of  air-flues  or  chimneys.  It' 
not  made  to  rotate  according  to  the  direction  of  the  wind 
by  means  of  vanes,  they  should  be  so  constructed  as  to 
prevent  the  entrance  of  rain.  Among  cowls  which  have 
received  favourable  notice  may  be  mentioned  the  various 
cowls  patented  by  Banner,  Bond,  Boyle,  Buchan,  Ellison, 
Scott,  Dunn  and  Co.,  and  Wawn  and  Wilcox. 

According  to  some  recent  experiments  conducted  by 
a  Committee  of  the  Sanitary  Institute  at  Kew  Gardens, 
the  great  majority  of  cowls  tested  showed  no  superiority 
in  aspirating  power  over  the  simple  open  tube. 

Louvres  are  sometimes  used  instead  of  cowls,  but, 
unless  specially  constructed,  they  are  apt  to  let  in  the 
rain  and  permit  down-draughts. 

In  several  plans  of  natural  ventilation  the  perflating 
and  aspirating  powers  of  the  wind  are  both  taken  advan- 
tage of.  Thus,  in  Mr.  Sylvester's  plan,  which  was  in  use 
fifty  years  ago,  a  large  cowl  surmounted  the  fresh  air 
entrance  shaft,  and  by  means  of  a  vane  was  always  made 
to  face  the  wind.  The  shaft  itself  was  erected  at  a  con- 
venient distance  from  the  building  to  be  ventilated,  and 
of  a  height  varying  according  to  circumstances.  In  this 
way  the  air,  so  to  speak,  was  blown  into  the  cowl  and 
down  the  entrance-shaft  into  a  chamber  beneath  the  base- 
ment floor,  where  it  could  be  heated  if  necessary.  It 
then  ascended  by  tubes  leading  to  the  different  parts  of 
the  building,  and  finally  passed  out  through  a  shaft  or 


104  VENTILATION  AND  WARMING. 

shafts  projecting  above  the  roof,  and  also  fitted  with  cowls 
turning  away  from  the  wind,  so  as  to  act  as  aspirators. 

By  a  suitable  arrangement  of  shafts  and  cowls,  this 
mode  of  natural  ventilation  can  be  made  to  do  excellent 
service  in  ships,  and  in  buildings  so  constructed  or  situ- 
ated that  other  ventilating  means  will  not  suffice.  It 
was  on  this  principle  that  Dr.  Arnott  ventilated  the  Field 
Lane  Eagged  School  so  successfully.  The  entrance  and 
exit  tubes  were  both  fitted  with  cowls,  the  one  set  turning 
away  from  the  wind,  the  other  facing  the  wind.  The 
latter  also  were  of  a  higher  elevation  than  the  former,  in 
order  to  increase  their  extractive  power. 

A  system  of  natural  ventilation,  well  suited  for  large 
rooms,  and  which  has  been  highly  spoken  of  by  Mr. 
Eobson,  architect  to  the  London  School  Board,  is  that 
devised  by  Mr.  Potts.  It  consists  of  a  hollow  metal 
cornice  running  continuously  round  the  room,  and  divided 
longitudinally  throughout  its  whole  length  into  two 
separate  channels,  by  a  plate  attached  to  the  lower  one. 
The  fresh  air  is  admitted  through  openings  in  the  wall 
into  the  lower  channel,  and  falls  imperceptibly  into  the 
room  through  numerous  perforations.  The  upper  channel 
communicates  either  with  the  smoke-flue  or  other  air- 
shaft,  and  receives  the  vitiated  air  through  a  series  of 
small  openings  similar  to  those  of  the  lower  channel.  As 
the  fresh  air,  being  colder,  descends  by  its  own  gravity, 
and  the  vitiated  air,  being  warmer,  rises  to  the  highest 
point,  there  is  no  doubt  that  the  principles  of  the  system 
are  correct.  Mr.  Eobson  strongly  recommends  it  for 
facility  of  application  to  buildings  originally  erected 
without  proper  provision  for  ventilation,  for  sightliness, 
economy  of  first  cost,  and  self-acting  properties. 

Another  plan,  which  has  been  found  to  work  well  in 
schools,  has  been  proposed  by  Mr.  H.  Yarley.  A  per- 
orated zinc  tube,  communicating  with  the  external  air 


VENTILATION  AND  WARMING.  105 

passes  along  the  cornice  of  three  sides  of  the  room,  while 
on  the  fourth  side  another  perforated  tube  is  connected 
with  the  chimney,  which  acts  as  the  extraction-shaft. 

The  plan  proposed  by  Mr.  M'Kinnell,  though  it 
belongs  to  the  same  category,  is  less  widely  applicable 
than  either  of  these  two,  because  it  is  only  suited  for  one- 
storied  buildings  or  upper  rooms.  It  consists  of  two 
hollow  cylinders,  one  within  the  other,  and  of  such  relative 
calibre  that  the  transverse  area  between  the  tubes  is  equal 
to  the  sectional  area  of  the  inner  tube.  The  inner  tube 
is  of  slightly  higher  elevation  than  the  outer,  and  acts  as 
the  outlet.  The  fresh  air  enters  between  the  tubes,  and 
is  thrown  up  towards  the  ceiling  by  means  of  a  horizontal 
flange  surrounding  the  lower  margin  of  the  inner  tube. 
Both  tubes  should  be  situated  in  the  centre  of  the  ceiling 
or  roof. 

For  ventilating  workshops  or  factories,  another  plan 
has  been  advocated,  which  appears  to  possess  some 
special  merits  beyond  those  of  mere  novelty.  -It  pro- 
poses that  the  ceiling  of  every  workshop  should  be 
formed  of  zinc  or  oiled  paper  pierced  by  numerous  small 
holes.  Above  this  perforated  ceiling,  and  between  it  and 
the  roof,  or  between  it  and  the  next  floor  above,  there 
should  be  a  free  space  or  air-chamber  open  to  the  atmo- 
sphere on  all  sides.  This  plan,  while  it  would  not  interfere 
with  ventilation  by  open  windows  nor  with  ordinary 
methods  of  warming,  would  give  free  play  to  the  different 
modes  of  natural  ventilation,  and  is  intended  to  supply, 
as  nearly  as  possible,  the  conditions  of  living  in  the  open 
air,  summer  and  winter,  without  exposure  to  extremes  of 
weather. 


106  VENTILATION  AND  WAKMING. 


SECTION  IV. 
AETIFICIAL  VENTILATION  AND  WARMING. 

It  will  be  convenient  to  consider  these  two  subjects 
conjointly. 

Artificial  ventilation  is  carried  on  either  by  forcing 
the  air  into  and  through  a  room  (propulsion),  or  by  draw- 
ing the  air  out  of  a  room  (extraction).  These  two  methods 
are  also  spoken  of  as  the  plenum  and  vacuum  systems  of 
ventilation. 

Although  it  may  appear  to  be  an  easy  matter  to 
ventilate  a  room  without  any  regard  to  temperature,  or 
to  warm  it  without  providing  for  a  due  supply  of  fresh 
air,  it  becomes  a  problem  of  very  considerable  difficulty 
to  ensure,  in  all  cases,  that  both  the  ventilation  and  warm- 
ing shall  be  efficient  and  satisfactory.  This  difficulty 
depends  in  a  great  measure  on  the  fact  that  the  means 
employed  in  ventilating  necessarily  dissipate  and  carry 
off  a  certain  quantity  of  the  heat  which  should  be  utilised 
for  warming  purposes. 

In  this  country  artificial  ventilation  and  warming  are 
usually  provided  for  by  open  fire-places.  The  heat  is 
obtained  by  radiation  from  the  incandescent  fire,  and  by 
radiation  and  reflection  from  the  different  parts  of  the 
grate,  while  ventilation  is  carried  on  by  the  constant 
current  of  heated  air  rushing  up  the  chimney.  Even 
when  there  is  no  fire,  the  chimney  acts  as  a  very  efficient 
ventilating  shaft. 

When  doors  and  windows  are  closed  and  a  fire  kept 
burning,  the  fresh  air  enters  the  room  through  every 
chink  and  opening,  provided  there  are  no  special  inlets. 
Hence  it  follows  that  the  more  closely  doors  and  win- 
dows are  made  to  fit,  so  much  greater  are  the  obstacles 
to  the  entrance  of  fresh  air.  When  this  is  the  case,  the 


VENTILATION  AND  WARMIXC;.  107 

fire  feeds  itself  by  establishing  a  double  current  in  the 
chimney,  the  downward  current  entering  the  room  in 
puffs,  and  carrying  with  it  clouds  of  smoke.  Generally, 
however,  doors  and  windows  are  not  made  to  fit  so  closely 
that  a  sufficient  amount  of  air  for  feeding  the  fire  cannot 
enter,  and  under  ordinary  circumstances  the  supply  and 
circulation  are  somewhat  as  follows  : — The  greater  portion 
of  the  fresh  air  enters  beneath  the  door,  and  is  drawn 
along  the  floor  towards  the  fire-place.  It  is  warmed  to  a 
certain  extent  during  its  course  by  the  radiating  heat  of 
the  fire,  and  when  it  approaches  the  fire-place,  part  of  it 
rushes  up  the  chimney  along  with  the  smoke,  while  the 
other  part  ascends  towards  the  ceiling,  and  after  ascending- 
passes  along  the  ceiling  towards  the  opposite  end  of  the 
room.  During  its  progress  it  becomes  cooled,  and  there- 
fore descends  to  be  again  drawn  towards  the  fire-place 
with  a  fresh  supply  from  beneath  the  door  and  through 
the  chinks  of  the  window-frames,  if  they  are  not  air-tight. 
As  the  air  which  thus  enters  is  usually  cold  air,  it  is 
evident  that  the  room  is  insufficiently  or  unequally 
warmed  and  badly  ventilated.  At  the  end  of  the  room 
opposite  the  fire-place  the  temperature  is  below  the 
average,  and  the  cold  current  near  the  floor  chills  the 
feet.  Moreover,  the  air  is  not  properly  diffused,  so  that 
although  a  sufficient  supply  may  actually  be  entering, 
impurities  are  apt  to  accumulate  in  the  centre  and  upper 
parts  of  the  room. 

The  position  of  the  fire-place  is  likewise  a  matter  of 
considerable  importance.  The  practice  followed  by  most 
builders  is  to  place  fire-places  in  external  walls,  by  which 
means  a  large  amount  of  heat  is  wasted.  If,  on  the  other 
hand,  they  are  grouped  in  the  centre  of  the  house,  more 
heat  is  utilised,  and  greater  equability  of  the  inside 
temperature  is  maintained. 

With    ordinary  fire-places   it  is    found  that  nearly 


108 


VENTILATION  AND  WARMING. 


seven-eighths  of  the  heat  generated  passes  up  the  chim- 
ney, along  with  a  quantity  of  air  varying  from  6000  to 
20,000  cubic  feet  per  hour.  While,  therefore,  a  single 
chimney  will  on  the  average  act  as  an  efficient  ventilating 
shaft  for  a  room  containing  from  three  to  six  or  more 
persons,  it  is  quite  clear  that  by  far  the  greatest  portion 
of  the  fuel  is  wasted  as  a  warming  agent.  The  structure 
of  the  fire-place  thus  becomes  a  matter  of  special  import- 
ance, because  not  only  may  the  fuel  be  economised  to  a 
considerable  extent,  but  by  certain  mechanical  arrange- 


Fig.  1.-- Elevation,  showing  air 
ancV  smoke  flues. 


Fig.  2.— Section  of  Grate. 


Fig.  3. — Section  of  a  room 
showing  air-duct  and  flues. 


Fig.  4. 


-Plan  of  grate  and  air- 
chamber. 


(After  GALTON.) 


ments  an  equable  temperature  may  be  maintained  and 
the  air  warmed  before  it  enters  the  room. 

Of  the  fire-places  adapted  to  meet  these  requirements, 
one  of  the  best,  although  it  has  now  many  rivals,  is  the 


VENTILATION  AND  WAKMIXd.  109 

stove  devised  by  Captain  Douglas  Galton  (see  Figs.  1,  2, 
3,  and  4).  It  provides  for  an  air-chamber  at  the  back, 
in  which  the  fresh  air  is  heated  before  it  enters  the  room. 
If  the  fire-place  be  built  in  an  external  wall,  the  inlet  for 
fresh  air  may  be  situated  immediately  behind,  but  if  in 
an  inner  wall,  a  channel  communicating  with  the  external 
air  by  perforated  bricks  or  gratings,  and  passing  beneath 
the  flooring  or  behind  the  skirting,  must  be  laid,  On  the 
back  of  the  stove  broad  iron  flanges  are  cast,  so  as  to 
present  as  large  a  heating  surface  as  possible.  These 
project  backwards  into  the  chamber,  and  this  heating- 
surface  is  further  supplemented  by  the  smoke  flue,  also  of 
iron,  which  passes  through  the  chamber,  and  is  made 
continuous  with  the  chimney.  The  fresh  air  heated  in 
this  manner  enters  the  room  by  a  louvred  opening  situ- 
ated between  the  fire-place  and  ceiling,  or  by  two  such 
openings,  one  at  either  side  of  the  chimney-breast.  The 
grate  itself  is  so  constructed  that  the  greatest  amount  of 
obtainable  reflected  heat  is  given  off,  and  a  more  perfect 
combustion  of  the  smoke  effected  than  with  an  ordinary 
grate.  The  stoves  are  of  different  designs  and  sizes,  to 
suit  existing  chimney-openings  and  different  sized  rooms. 
They  have  the  same  cheerful  aspect  as  the  ordinary  grate, 
and  produce  the  same  degree  of  warmth  in  a  room  with 
a  third  of  the  quantity  of  fuel ;  besides,  the  temperature 
of  the  room  is  much  more  equable,  and  unpleasant  draughts 
of  cold  air  are  avoided.  In  Boyle's  ventilating  grates, 
which  are  perhaps  more  ornamental,  the  heated  air  enters 
the  room  through  a  transverse  fenestrated  opening  extend- 
ing along  the  top  of  the  grate.  In  Shorland's  patent 
Manchester  grate,  which  has  been  highly  spoken  of,  the 
warmed  outside  air  is  made  to  enter  the  room  through 
the  shelf  of  the  chimney-piece,  and  by  means  of  special 
flues  it  can  be  conveyed  to  bedrooms  above.  Kitchen 
stoves  have  also  been  constructed  on  the  same  principle, 


1  1  0  \T\  I'll   \TION     \\M    \V  MIMINC. 

and  stoves  suited  for  the  centre  of  halls  or  wards.  The 
Smoke-Hue  of  llie  latter  is  made  to  pass  out  under  I  he 
Mooring,  and  inside  the  fresh-air  entrance  ehannel,  thus 
supplying  a  larger  heat  in;;-  area  for  the  entering  air.  The 
terra-cotta  stoves  in  Herbert  Hospital  are  of  this  descrip- 
tion. But  SO  many  radiating  grates  have  lately  been 
patented  that  it  would  be  impossible  to  gi\e  any  selected 
list  here.  Indeed,  with  regard  to  grates,  kitcheners,  and 
stoves  of  all  kinds  which  have  been  specially  commended, 
the  reader  is  referred  to  the  list  of  the  awards  given  at 
the  recent  Smoke  Abatement  Inhibition  held  at  South 
Kensington.  (See  &i  nit  tin/  ./iVren/,  August  15,  1S8L'.) 

At  this  exhibition  numerous  grates  were  shown,  which. 
in  addition  to  (heir  warming  properties,  were  specially 
devised  to  economise  fuel  and  consume  their  own  smoke. 
Tlu4  vast  majority  of  grates  at  present  in  use  are  con- 
structed on  wrong  principles  by  allowing  the  cold  air  to 
rush  through  the  centre  of  the  tire,  thus  causing  vapid 
consumption  of  the  fuel,  and  sending  the  warmth  along 
with  the  half-bnvued  gases  up  the  chimney.  In  order  to 
economise  fuel  it  is  necessaiy  to  cut  off  this  stream  of 
cold  air  which  passes  through  the  bottom  of  the  grate, 
an  arrangement  which  is  carried  out  in  all  grates  made 
with  solid  tire-brick  bottoms,  after  the  pattern  of  the 
Parson's,  Abbotsford,  or  Kyrle  grates.  l»ut .  as  "Mr.  Pridgin 
Teale  has  so  clearly  pointed  out  in  a  small  brochure  on 
economy  of  coal,  the  same  results  can  be  obtained  by 
closing  up  the  open  chamber  under  the  grate  by  means 
of  a  close-tilting  shield  or  door,  which  can  be  made  by 
any  blacksmith  or  ironmonger.  Indeed,  according  to  Mr. 
Teale's  experiments,  grates  provided  with  these  shields,  or 
"  economisevs  "  as  he  calls  them,  answer  better  than  those 
with  solid  tire-brick  bottoms,  and  he  gives  some  excellent 
rules  regarding  the  construction  or  alteration  of  tire-places, 
which  arc  of  such  general  application  that  they  may  be 


Tir.ATIo.N    AND    WAUM!  1   1   1 

fitly  (piotcd   liens:-    "1.    Use  as   much    lire-hriek    MMJI 
litllc  Iron  M  possible.       "2.   Tin-,  bark  and  sides  of  the  lire- 
plare    sli(.ul<l   lie  made  of   lire  hiirk.       ."..    Tin-  hark  of    I  he 
lire  place  •  hould  lean  or   arcb  over  the  lin-.      -J.    The  hot  - 

tnlii     of    the     lire    01     gratlDg     -hould     lie    deep     from      before 

barkwanh  (not,  less  t.han  !i  indies,  for  a  small  room). 
5.  Tin-  slils  iii  the  grating  should  be  narrow.  (\.  The 
l»;irs  iii  fn.nl,  should  he  narrow.  7.  The  <-h;i)iiher  bfl 
ne;ilh  the  lire  should  In-  dn-^-d  in  fnml  l»y  ;i  shield  or 
'(•••., IK, miser.'  In  li"hti]i"  ih<-  iin-  it  is  well  to  dr;i\v 
:i\v;iythc  cconoini«-i-  lorn  short  time  until  the  lire  is  well 
taL  II  mi  '  i ••  •oiiomiscr '  is  not  used,  considerable 

ing   of    fuel     IIKIV    lie    ellcdcd    l,y    hnviii;;    ;ui    iron     |il;ile 

iu;idc  lo  fil  Uie  bottom  of  the  grate  and  laid  on  the  bars." 
<lre;ii  !iiipro\cinen(s,  too,  have  recently  been  made 
in  close  stoves  mid  kite  hdici-.  holh  as  regards  economy 
of  fuel  ;ind  smoke  abatement,  wbile  -as-cooking  stoves 
;nv  (•••niiii;.'  into  much  iimn-  -eneral  use,  especially  durin." 
(he  MimiiHT  nioiiihs.  Thei-c  ;in-  also  several  very  admii- 

.'ible    -;r     Veillilllll  e.S,  SUCh   OS  tile    \Vel  l-kim\Vll    (Jalo- 

invenled    by    Air.    Oeorge,   and     Dr.    I  loud' 
KuthenmV  \rent  il;il  iii"  Sl«»\e,  manur.-icl  uivd  liy  lint  (Jlou- 

BC  Sanilary  and  l'>oiiomic  Association.  l''or  wai'n 
and  venlilalin^  bedrooms,  1  he  (liermie  venl  ilalnr  d«-\  i 
by  Mr.  l.au^oii  Tail  ol'  I'.ii  nun-ham  may  be  luenl  imn-d  a 

.1  cheap  ;ind  ei'jed i\c  arrangement 

The    "Tea!      ohjertiull    (i,    HiailV    of     the    e«  •)  1 1 1 1  |o|  |e  }•     Kind- 
'o\C      depend-    nn    (he    fart,    thai      their     nver-liealed    SUr- 

dry    the    air    to    a    very    un\\holesoi.  !,    even 

\\heii  the  fiv  h  air  is  runveyed  by  ;i  .special  entranee 
ehannel.  N  umbers  of  I  hem,  lm\\  ever,  are  put  up  \\ilhout 
]>rovidin-  any  suc-Ii  rhaniiel,  |Q  that  tiir  air  not  only  hr- 
eoinr-;  dry  and  he.int,  hut  r.\r(.rdin;jly  <  !<>•  c  and  un pica  -ant. 
luap-iialiii"  dishes  place. |  t)n  tbc  itOVM  v\ill  Mlifl  in 
reinedyin-  tin's  evil,  0T  painliu;-  tin-  imn  sinia.e  \\itli  a 


112  VENTILATION  AND  WARMING. 

solution  of  silica,  as  suggested  by  Dr.  Bond;  but  it  is  much 
preferable,  and  in  the  long  run  more  economical,  to  have 
a  good  ventilating  stove  erected  in  the  first  instance. 

For  all  ventilating  stoves  it  is  necessary  that  the 
fresh-air  channels  should  be  removed  from  all  sources  of 
contamination,  such  as  drains,  closets,  stables,  etc. ;  and 
it  is  advisable  to  protect  the  external  openings  by  per- 
forated bricks  or  gratings.  The  size  of  the  stove,  and 
the  sectional  area  of  the  air-channel,  must  of  course  be 
regulated  by  the  size  of  the  space  which  is  to  be  warmed 
and  ventilated. 

Stove  smoke -flues  may  be  either  ascending  or  de- 
scending, but  in  the  latter  case  a  pilot-stove  or  rarefier 
ought  to  be  fixed  at  the  base  of  the  upright  chimney 
which  receives  the  flue,  otherwise  the  draught  may  prove 
faulty.  Soot  doors  should  be  provided  at  all  the  bends, 
wherever  practicable. 

With  the  ordinary  grate  the  ventilation  of  a  room 
may  be  very  greatly  improved  by  providing  an  entrance 
into  the  chimney  near  the  ceiling,  and  to  prevent  reflux  of 
smoke,  the  opening  should  be  valved,  as  in  Dr.  Arnott's 
chimney  ventilator,  or  Crossley's  noiseless  ventilators. 
One  or  more  openings  for  the  entrance  of  fresh  air  could 
be  obtained  by  inserting  perforated  bricks  or  Sheriiigham 
valves  in  the  outer  walls,  also  near  the  ceiling,  but  at  a 
distance  from  the  fire-place,  or  by  adopting  one  or 
other  of  the  several  contrivances  mentioned  in  the  pre- 
vious section.  Indeed  the  mistake  which  is  common  to 
the  great  majority  of  houses  consists  in  providing  an  outlet, 
generally  the  chimney,  and  neglecting  to  provide  an  inlet, 
whereas  the  essential  principle  of  ventilating  demands 
that  there  shall  be  at  least  two  openings,  one  of  which 
shall  act  as  an  inlet,  and  the  other  as  an  outlet,  according 
to  circumstances. 

Instead  of  an  opening  leading  directly  into  the  chim- 


YKXTILATIOX  AND  WARMING.  113 

ney  for  an  outlet,  a  much  better  plan  is  to  have  a  flue  ' 
running  alongside  the  chimney,  the  entrance  to  the  flue 
being  situated  near  the  ceiling.  The  hot  air  in  the  chim- 
ney warms  the  flue,  and  there  is  thus  a  constant  upward 
current  established  without  any  risk  of  reflux  of  smoke. 
But  this  is  an  arrangement  which  can  only  be  attended  to 
in  the  original  plan  of  a  building ;  it  cannot  be  applied 
as  an  improvement  afterwards. 

Some  architects  recommend  that  all  the  rooms  in  a 
well-constructed  house  should  be  supplied  with  warm  air 
from  the  hall  and  staircase.  In  Mr.  Ritchie's  plan  the 
air  is  heated  to  about  70°  Fahr.,  and  enters  the  various 
rooms  through  longitudinal  openings  over  each  door. 
After  being  diffused  through  the  rooms,  it  then  passes  up 
the  chimneys  and  through  flues  reaching  from  the  ceiling 
to  the  wall-heads  under  the  roof. 

Somewhat  similar  to  this  is  the  plan  devised  some 
time  ago  by  Drs.  Dry  sd  ale  and  Hay  ward  of  Liverpool. 
The  fresh  air,  warmed  by  a  coil  of  hot-water  pipes  in  the 
basement,  is  admitted  into  a  central  hall  containing  the 
staircase  and  separate  landings,  from  which  it  enters  the 
several  rooms  by  suitable  openings  supplied  by  valves, 
and  from  these  again  it  is  conveyed  to  special  outlets  in 
the  ceilings,  converging  to  a  foul-air  chamber  under  the 
roof.  From  this  foul-air  chamber  there  is  a  downcast 
shaft  communicating  with  the  kitchen  fire,  which  is  thus 
made  to  act  as  an  extraction  furnace. 

With  regard  to  these  and  other  complicated  methods 
of  house -ventilation,  it  has  to  be  pointed  out  that  no 
system  is  to  be  commended  which  dispenses  with  the 
opening  of  windows  occasionally  in  order  to  secure 
thorough  perflation.  No  doubt,  it  adds  greatly  to  the 
comfort  of  a  house  if  the  air  in  the  hall  is  warmed,  and 
it  will  also  add  greatly  to  comfort  if  the  air  thus  warmed 
can  be  introduced  into  the  rooms  by  suitable  openings  ; 

I 


114  VENTILATION  AND  WARMING. 

but  even  in  winter  the  windows  should  be  thrown  open 
for  a  brief  period  at  least  every  morning,  and  in  summer, 
window-ventilation  should  be  chiefly  depended  on,  and 
the  entrance-hall,  if  louvred  in  the  roof,  would  act  as  an 
extraction-shaft. 

Large  and  compact  buildings,  such  as  hospitals, 
asylums,  and  prisons,  can  be  very  efficiently  warmed  and 
ventilated  by  a  suitable  arrangement  of  steam-coils  or  hot- 
water  pipes.  The  fresh  air,  as  it  enters  through  openings 
properly  distributed  throughout  the  building,  is  warmed 
by  passing  over  the  pipes,  while  the  vitiated  air  may  be 
extracted  by  means  of  other  coils  of  heated  pipes  situated 
in  extraction-shafts. 

Another  mode  of  ventilation  by  extraction,  and  one 
which  is  frequently  used  in  prisons,  consists  in  having 
a  large  foul -air  extraction  shaft  or  shafts,  heated  by  a 
furnace  at  the  bottom,  and  into  which  foul-air  flues,  lead- 
ing from  all  parts  of  the  building,  are  conducted.  The 
workmanship  in  this  case  requires  to  be  very  perfect,  so 
as  to  prevent  any  large  currents  of  air  reaching  the  shaft 
except  through  the  flues. 

/  /       By  a  combination  of  these  two  methods — viz.  heating 

)      the   fresh   air  before  entering   by  hot -water   pipes,  and 

t      securing  the  removal  of  the  vitiated  air  by  flues  leading  to 

furnace-shafts — the  largest  buildings  can  be  well  warmed 

and  ventilated.     If  necessary,  the  hot- water  pipes  may  be 

made  to  pass  through  shallow  basins  of  water,  to  ensure 

a  sufficiency  of  moisture  in  the  contained  air. 

As  an  instance  of  the  successful  ventilation  of  a  large 
hall,  which  until  recently  was  notorious  for  its  defects  in 
this  respect,  may  here  be  mentioned  the  improvements 
which  were  carried  out  in  1882  in  the  Council  Chamber 
of  the  Guildhall,  London,  by  Messrs.  Boyle  and  Son,  the 
well-known  ventilating  engineers.  The  conditions  under 
which  they  undertook  to  remedy  the  existing  defects  were 


VENTILATION  AND  WARMING.  115 

of  the  most  stringent  nature,  but  they  were  carried  out 
so  completely  as  to  meet  the  approval  not  only  of  the 
committee  appointed  to  enforce  them,  but  of  numbers  of 
well-known  writers  on  ventilation,  who  were  invited  to 
test  and  examine  the  working  of  the  system,  which  is,  in 
the  main,  automatic.  Briefly  stated,  the  plan  adopted 
by  Messrs.  Boyle  was  as  follows  : — For  thejnlet  of  fresh 
air,  sixteen  vertical  ventilating  shafts,  projecting  only 
about  three  inches  from  the  walls,  were  placed  in  various 
parts  of  the  chamber,  and  with  outlets  at  different 
altitudes,  so  as  to  admit  the  fresh  air  at  different  heights. 
These  shafts  are  fitted  with  patent  heaters,  which  are 
warmed  by  means  of  a  gas  jet  fixed  by  the  side  of  each 
shaft  and  enclosed  in  a  metal  casing,  so  that  the  tem- 
perature of  the  incoming  air  can  be  regulated  by  raising 
or  lowering  the  gas  jets.  The  heat  imparted  by  each  gas 
jet  is  carried  up  inside  the  shaft  to  a  certain  height  by  a 
tube,  which  then  crosses  it,  and  is  brought  down  zigzag 
fashion  to  a  small  receptacle  at  the  bottom,  which 
receives  the  water  of  condensation,  and  transmits  it,  along 
with  the  other  products  of  combustion,  through  a  small 
tube  to  the  outside.  By  this  means  a  constantly  induced 
current  of  fresh  air  can  be  kept  up  in  all  the  shafts,  what- 
ever be  the  temperature  of  the  outside  air ;  while  the 
vitiated  inside  air  is  extracted  by  shafts  springing  from 
various  parts  of  the  ceiling  through  roseate  perforations, 
and  converging  to  patent  exhaust  cowls  on  the  roof. 

Almost  all  large  mines  are  ventilated  on  this  principle 
of  extraction.  By  means  of  a  furnace  at  the  bottom  of 
the  upshaft,  the  air  is  drawn  down  another  shaft  and 
made  to  traverse  the  various  galleries  by  an  arrangement 
of  partitions  and  double  doors.  In  well- ventilated  mines 
as  much  as  2000  cubic  feet  of  air  per  head  per  hour  can 
be  supplied  in  this  way,  and  in  fire-damp  mines,  6000. 

In  men-of-war  and  steam-vessels  an  iron  casing  sur- 


116  VENTILATION  AND  WARMING. 

rounding  the  bottom  of  the  funnel  and  upper  part  of  the 
boilers  is  utilised  as  an  extraction  shaft.  When  the  fires 
are  kept  burning,  so  great  is  the  current  which  rushes  up 
this  shaft,  that  the  air  can  be  drawn  through  the  hatch- 
ways from  all  parts  of  the  vessel,  and  even  the  hold  and 
timbers  ventilated. 

In  theatres,  and  other  buildings  of  a  similar  descrip- 
tion, the  chandeliers  should  always  be  employed  to  extract 
the  vitiated  air.  According  to  the  experiments  of  General 
Morin,  one  cubic  foot  of  gas  can  be  utilised  so  as  to  cause 
the  discharge  of  1000  cubic  feet  of  air.  Apart,  therefore, 
from  the  great  advantages  arising  from  the  direct  removal 
of  the  products  of  combustion,  the  aid  to  ventilation  fur- 
nished by  the  extractive  power  of  gas-lights  merits  special 
attention,  for  as  a  common  gas-burner  will  burn  nearly 
3  feet  of  gas  per  hour,  its  extractive  power  could  thus 
be  utilised  to  remove  nearly  3000  cubic  feet  of  vitiated 
air  during  the  same  period.  Where  a  large  flood  of  light 
is  required,  the  "  sun-burner  "  acts  very  efficiently  in  this 
way,  and  for  smaller  rooms  or  workshops,  the  "  box-top 
sun -burner"  is  found  to  answer  very  well.  Eickett's 
new  "ventilating  globe-light"  ought  also  to  be  mentioned 
amongst  the  latest  improvements  in  this  direction.  It  is 
so  arranged  that  so  soon  as  the  gas  is  lighted,  an  upward 
current  is  produced  in  the  main  tube,  and  as  this  becomes 
heated,  the  air  in  the  surrounding  tube  near  the  ceiling 
becomes  rarefied  and  set  in  motion.  In  this  way  the 
heated  air  in  both  tubes  is  carried  to  a  special  shaft  or  to 
the  chimney,  thereby  securing  the  removal  of  the  products 
of  combustion,  and  a  steady  current  outwards  of  the 
vitiated  air  in  the  room.  Tubes  of  tin  or  zinc  placed 
over  common  burners,  and  communicating  with  the 
external  air,  or  leading  into  the  chimney,  would  answer 
the  same  purpose  where  ornamentation  can  be  dispensed 
with ;  but  in  either  case  it  is  necessary  that  the  room 


YKNTILATION  AND  WARMING.  11 7 

should  be  well  ventilated,  otherwise  the  extractive  force 
of  the  fire  will  most  likely  occasion  a  down-draught 
through  the  ventilating  tubes. 

Extraction  by  means  of  a  steam  jet,  and  extraction 
by  a  fan  or  screw,  are  now  generally  abandoned  on  the 
large  scale.  What  is  known  as  the  Archimedean-screw 
ventilator,  however,  has  been  lately  recommended  for 
small  air-shafts,  and  has  also  been  applied  to  large  fac- 
tories, where  it  may  be  worked  by  hand  or  steam  power. 
In  mines,  the  fan  has  been  made  to  extract  as  much  as 
45,000  cubic  feet  of  air  per  minute. 

The  system  of  ventilation  by  propulsion  was  first 
introduced  by  Dr.  Desaguliers  in  1734.  It  is  carried 
on  by  means  of  a  fan  enclosed  in  a  box,  which  can  be 
worked  by  hand,  horse,  water,  or  steam  power.  The  air 
enters  through  an  opening  in  the  centre  of  the  box,  and 
is  thrown  by  the  revolving  fan  into  a  conduit  which  com- 
municates by  proper  channels  with  the  different  parts  of 
the  building.  In  France  and  America  the  fan  is  employed 
in  the  ventilation  of  several  of  the  large  hospitals,  the  air 
being  forced  into  a  basement  chamber,  where  it  is  heated 
before  it  enters  the  wards.  This  is  known  as  Van 
Hecke's  system.  In  this  country  St.  George's  Hall, 
Liverpool,  may  be  cited  as  affording  an  example  of  venti- 
lation by  propulsion  on  the  large  scale.  The  air  is  taken 
from  the  basement,  and  washed  by  being  passed  through 
a  thin  film  of  water  thrown  up  by  a  fountain.  It  is  then 
passed  in  cold  weather  into  vessels  for  the  purpose  of 
being  warmed,  and  in  which  it  can  be  moistened  by  a 
steam  jet  whenever  the  difference  between  the  dry  and 
wet  bulb  exceeds  5°,  and  finally,  it  is  propelled  along 
different  channels  into  the  hall.  In  summer,  the  air  in 
the  conduits  is  cooled  by  the  evaporation  of  water. 

Various  other  methods  of  propulsion  have  been  tried, 
such  as  the  bellows  arrangement  proposed  by  Dr.  Hales, 


118  VENTILATION  AND  WARMING. 

or  the  gasometer  pump  worked  by  hydraulic  pressure 
planned  by  Dr.  Arnott,  but  mostly  all  of  them  have 
fallen  into  disuse. 

Concerning  the  relative  merits  of  these  two  systems 
of  ventilation,  viz.  extraction  and  propulsion,  the  balance 
of  evidence  is  most  decidedly  in  favour  of  the  former,  as 
regards  cost,  efficiency,  and  stability.  In  either  system, 
natural  ventilation  plays  a  most  important  part,  whether 
it  be  taken  into  consideration  in  the  construction  of 
buildings  or  not;  and  hence  every  facility  should  be 
afforded  for  its  operation,  without  at  the  same  time  per- 
mitting its  disadvantages  to  take  effect.  For  dwelling- 
houses,  workhouses,  asylums,  barracks,  and  hospitals,  there 
is  no  doubt  that  natural  ventilation,  aided  by  the  ex- 
tractive power  of  the  heat  generated  in  warming  and 
lighting,  is  by  far  the  best  system.  On  the  other  hand, 
buildings  such  as  prisons,  theatres,  etc.,  must  be  venti- 
lated by  mechanical  appliances,  and  experience  has  proved 
that  these  should  provide  for  ventilation  by  extraction. 

General  Considerations. — With  regard  to  the  relative 
position  of  inlets  and  outlets,  there  seems  to  be  some 
difference  of  opinion.  Theoretically,  the  inlets  for  the 
fresh  air  should  be  situated  near  the  floor,  and  the  outlets 
near  the  ceiling :  but  the  question  of  temperature  inter- 
feres with  the  practical  application  of  this  rule.  If  the 
air  is  not  warmed  before  entering,  the  inlets  should  be  at 
least  nine  or  ten  feet  from  the  floor,  or  close  to  the  ceiling, 
and  so  constructed  that  the  cold  air  will  impinge  against 
the  roof,  and  fall  gently  into  the  room.  They  should 
slope  upwards  to  prevent  entrance  of  rain,  and  should 
communicate  with  the  external  air  by  means  of  perforated 
bricks  or  gratings  so  as  to  divide  the  entering  current  and 
break  its  force.  With  vertical  tubes  such  as  Tobin's  or 
Shorland's  tubes,  the  inlets  need  only  reach  about  six  feet 
from  the  floor.  Sliding  covers,  valves,  or  rotatory  discs 


VENTILATION  AND  WARMING.  119 

might  also  be  provided,  in  order  that  they  may  be  partially 
or  totally  closed  during  rough  weather.  If  the  air  is 
warmed  before  entering,  the  inlets  may  be  situated,  and 
generally  are  situated,  near  the  level  of  the  floor.  But 
in  either  case  it  is  essential  that  they  should  be  equally 
distributed  throughout  the  room,  to  ensure  proper  diffu- 
sion, and  that  the  structural  arrangements  should  permit 
of  their  being  readily  cleaned  out,  because  dirt  is  sure  to 
accumulate. 

The  outlets,  as  already  stated,  are  best  situated  in  or 
near  the  ceiling,  not  only  because  air  vitiated  by  respira- 
tion tends  to  ascend  on  account  of  its  lessened  density, 
but  because  experiment  proves  that,  given  the  same  ex- 
tractive power  and  the  same  size  of  outlet,  a  greater  volume 
of  air  passes  up  a  flue  whose  orifice  is  near  the  ceiling 
than  up  one  whose  orifice  is  near  the  floor.  Inlets  and 
outlets  should  not  be  situated  near  each  other,  otherwise 
the  entering  air  will  be  extracted  without  being  first 
diffused  throughout  the  room. 

Outlet  tubes,  or  foul-air  flues,  as  they  are  generally 
called,  should  be  smooth,  so  as  not  to  impede  the  current 
of  air  by  friction,  and  in  systems  of  ventilation  by  extrac- 
tion they  should  be  air-tight.  When  built  in  external 
walls  and  only  plastered,  I  have  frequently  satisfied  my- 
self by  experiment  that  the  outside  air  finds  its  way  into 
the  flue  and  sometimes  in  such  volume  that  though  there 
may  be  a  good  current  issuing  from  the  top,  scarcely  any 
current  can  be  detected  entering  it  at  the  bottom.  I  have 
also  found  that  when  the  wind  beats  strongly  against  the 
side  of  a  building,  with  foul-air  flues  situated  in  the  outer 
walls,  a  current  of  air  may  actually  be  issuing  from  both 
orifices  at  the  same  time.  The  experiments  of  Pettenkofer 
explain  how  readily  such  an  occurrence  may  take  place, 
for  he  has  proved  beyond  doubt  that  even  under  ordinary 
atmospheric  conditions,  a  very  considerable  interchange 


120  VENTILATION  AND  WARMING. 

of  gases  takes  place  through  common  dry-plastered  walls, 
and  indeed,  as  the  sick  often  experience,  very  perceptible 
draughts  find  their  way  through  outer  walls  when  a  stiff 
breeze  is  blowing.  All  foul-air  flues,  therefore,  should  be 
as  nearly  air-tight  as  possible,  and  if  they  were  made  of 
metal  tubing,  or  of  glazed  earthenware,  they  would  not 
only  satisfy  this  condition,  but  would  serve  greatly  to 
lessen  the  friction,  which  is  such  an  impediment'  to  ready 
extraction  through  common  plastered  flues.  It  is  further 
evident  that,  when  it  can  be  avoided,  they  should  not  be 
situated  in  external  walls,  because  in  cold  weather  the  air 
becomes  cooled  as  it  ascends,  and  unless  the  extractive 
power  is  very  considerable,  the  increased  weight  of  the 
column  of  air  by  loss  of  heat  will  counteract  the  ex- 
tractive force.  "Where  there  is  no  system  of  artificial 
extraction,  it  thus  often  happens  that  outlets  become 
inlets,  and  inlets  outlets. 

Another  very  important  point  remains  to  be  con- 
sidered, namely,  the  sectional  area  of  the  inlets  and  out- 
lets. As  atmospheric  conditions  are  constantly  varying, 
it  is  obviously  impossible  to  fix  upon  any  size  which  will 
meet  every  requirement. .  The  only  alternative,  therefore, 
is  to  provide  an  area  that  will  suit  the  majority  of  cases, 
and  which  will  be  capable  of  being  increased  or  diminished 
according  to  circumstances.  Dr.  Parkes  has  pointed  out 
that  in  this  country  a  size  of  24  square  inches  for  inlet 
per  head,  and  the  same  for  outlet,  is  the  one  best  adapted 
to  meet  common  conditions.  Theoretically,  the  sectional 
area  of  the  outlets  should  vary  according  to  the  height  of 
the  foul-air  flues,  and  the  Barrack  Commissioners  have 
accordingly  recommended  that  it  should  amount  to  1 
square  inch  for  every  50  cubic  feet  of  space  for  upper 
floors,  to  1  square  inch  for  every  55  cubic  feet  for  rooms 
below,  and  to  1  square  inch  for  every  60  cubic  feet  for 
rooms  on  the  ground-floor,  in  buildings  of  three  stories. 


VENTILATION  AND  WARMINC.  121 

Practically,  however,  these  nice  distinctions  may  be  dis- 
regarded, because  the  friction  in  long  flues  lessens  very 
considerably  the  advantage  in  extractive  power  attaching 
to  them,  on  account  of  their  greater  height,  and  also  because, 
in  the  great  majority  of  cases,  the  column  of  air  in  the 
flue  increases  in  density  the  higher  the  flue.  In  prisons, 
where  the  cubic  space  per  head  is  comparatively  small, 
the  sectional  area  of  inlets  and  outlets  should  be  at  least 
20  square  inches  per  head.  In  barracks,  hospitals,  etc., 
the  separate  inlets  should  not  exceed  1  square  foot,  other- 
wise the  entering  air  will  be  badly  distributed. 

More  precise  details  with  regard  to  the  ventilation  of 
hospitals  will  be  given  in  the  chapter  on  hospitals. 


122  EXAMINATION  OF  AIR  AND  VENTILATION. 


CHAPTEE  V. 

EXAMINATION  OF  AIR  AND  VENTILATION. 

A  DETAILED  examination  of  the  sufficiency  of  ventilation  in 
any  particular  case  will  embrace  the  following  inquiries : — 

1.  The  arrangements  as  regards  cubic  space,  the  rela- 
tive size  and  position  of  inlets  and  outlets,  the  distribution 
of  the  air,  and  the  amount  of  fresh  air  supplied. 

2.  The  examination  of  the  contained  air  by  the  senses. 

3.  Chemical  examination  of  the  contained  air. 

4.  Microscopical  examination  of  suspended  impurities. 

5.  Examination  as  regards  temperature,  moisture,  etc. 

SECTION  I. — EXAMINATION  AS  REGARDS  VENTILATING 
ARRANGEMENTS. 

The  measurement  of  the  cubic  space  is  a  simple 
question  of  mensuration,  but  corrections  must  be  made 
for  furniture,  bedding,  etc.,  and  for  inequalities  in  the 
contour  of  the  space  to  be  examined.  For  instance,  the 
displacement  caused  by  solid  projections  into  the  room 
must  be  deducted,  and  the  cubic  contents  of  open  recesses 
added.  The  allowance  for  each  bedstead  and  bedding 
may  be  estimated  at  10  cubic  feet,  and  for  the  space 
occupied  by  the  body  of  each  person  at  3  cubic  feet. 

After  the  exact  cubic  space  per  head  has  been  ascer- 
tained, the  next  points  to  be  inquired  into  are  the  relative 
position  and  size  of  inlets  and  outlets.  Perforated  bricks 
and  gratings  can  be  approximately  estimated,  as  regards 


EXAMINATION  OF  AIR  AND  VENTILATION.  123 

their  total  open  sectional  area,  by  taking  their  actual 
superficial  area,  and  calculating  the  relative  size  of  the 
interstices.  Inlets  should  be  inspected  as  regards  their 
freedom  from  accumulation  of  dust,  etc.,  and  outlets  as 
regards  the  presence  of  any  impediments  to  the  ready 
exit  of  the  vitiated  air.  Where  there  are  open  fire-places, 
the  sectional  area  of  the  smoke-flue  must  also  be  ascer- 
tained. The  existence  or  otherwise  of  unpleasant  draughts, 
and  the  relative  position  of  doors  and  windows,  and  how 
far  they  assist  in  the  ventilation  of  the  room,  are  other 
items  which  must  not  escape  notice.  If  the  system  of 
ventilation  is  artificial,  it  should  be  examined  in  all  its 
details,  and  in  this  examination  great  assistance  will  be 
derived  from  inspecting  the  architect's  plans,  whenever 
they  can  be  procured. 

The  directions  of  air-currents  in  a  room  can  be  ascer- 
tained by  means  of  the  smoke  from  smouldering  cotton 
velvet,  fibres  of  floss-silk,  small  pieces  of  feather,  small 
balloons  filled  with  hydrogen  gas,  etc.  The  flame  of  a 
candle  is  often  used  for  the  same  purpose,  but  it  is  of  no 
value  when  the  currents  are  delicate,  because  it  is  un- 
affected by  them,  but  is  of  considerable  service  in  showing 
whether  air  is  entering  or  issuing  through  any  opening. 
Very  frequently,  as  has  already  been  pointed  out,  open- 
ings that  are  meant  to  be  inlets  act  as  outlets,  and  vice 
/•'-/•#/,  or  the  movement  of  air  in  them  may  be  unstable, 
intermittent,  and  reversed  in  its  action,  now  entering  and 
now  issuing  through  the  same  opening. 

All  these  points,  and  others  which  may  arise  from 
peculiarities  of  structural  arrangement,  must  be  carefully 
inquired  into,  and  the  various  measurements  and  obser- 
vations noted  down  as  they  are  made.  When  the  venti- 
lation is  intended  to  be  carried  on  independently  of  open 
doors  and  windows,  these  should  be  closed  during  the 
examination. 


124  EXAMINATION  OF  AIR  AND  VENTILATION. 

In  determining  the  rate  of  movement  through  the 
various  openings,  an  instrument  called  an  anemometer 
is  generally  used.  This  may  briefly  be  described  as  a 
miniature  windmill.  The  little  sails,  driven  by  the  air- 
current,  set  in  motion  a  series  of  small  cogged  wheels, 
which  move  an  index  or  indices  on  a  dial-plate.  The 
velocity  of  the  current  can  thus  be  read  off  for  a  given 
time,  in  the  same  way  as  the  amount  of  gas  which  has 
been  consumed  is  ascertained  from  a  gas-meter.  A  very 
beautiful  and  delicate  instrument  of  this  description  has 
been  constructed  by  Mr.  Casella  of  Hatton  Garden,  with 
indices  on  the  dial-plate  indicating  the  velocity  of  an  air- 
current  in  feet,  hundreds  of  feet,  thousands,  etc.,  up  to 
millions.  By  moving  a  catch,  the  machinery  may  be 
stopped  at  any  moment  of  time.  With  this  instrument, 
the  rate  of  movement  of  air  through  any  opening  is 
readily,  and,  as  a  rule,  accurately  ascertained.  Before 
using  it,  the  index  indicating  feet  in  units  should  be  set 
at  zero,  and  the  relative  position  of  as  many  of  the  other 
indices  as  may  be  deemed  necessary  noted  down.  When 
the  instrument  is  placed  in  the  air-current,  time  is  called, 
and  the  catch  moved  to  set  the  machinery  free.  At  the 
end  of  one  minute,  two  minutes,  etc.,  according  to  the 
length  of  period  of  observation,  time  is  again  called,  and 
the  machinery  immediately  stopped  by  means  of  the  catch. 
The  linear  dimension  of  the  current  is  then  read  off,  and 
if  this  is  multiplied  by  the  sectional  area  of  the  opening, 
the  volume  of  air  which  has  passed  through  in  a  given 
time  can  be  easily  calculated  in  cubic  feet.  When  the 
instrument  is  placed  in  a  tube  or  shaft,  it  should  be  put 
well  in,  but  not  quite  in  the  centre,  because  the  velocity 
of  the  current  in  the  centre  is  greater  than  at  the  sides  of 
the  tube.  Should  the  shaft  be  large,  the  rate  of  move- 
ment ought  to  be  taken  at  different  parts,  and  the  average 
ascertained.  So  also,  when  the  rate  of  movement  is 


EXAMINATION  OF  AIR  AND  VENTILATION.  125 

irregular,  several  observations  should  be  made,  and  the 
average  of  the  whole  of  them  will  give  the  approximate 
velocity  of  the  current.  If  placed  in  a  tube  whose  sec- 
tional area  exceeds  but  very  little  the  space  occupied  by 
the  revolving  sails,  the  results  cannot  be  depended  on ; 
and  when  placed  at  the  entrance  of  a  tube,  for  example, 
against  a  perforated  air-brick  or  grating,  the  velocity  of 
the  current  indicated  by  the  anemometer  is  considerably 
less  than  what  exists  in  the  tube.  In  these  cases  the 
instrument  should  be  exactly  fitted  into  an  opening  in  a 
box,  large  enough  to  cover  completely  the  mouth  of  the 
tube,  by  which  means  the  whole  of  the  air  passing  through 
the  tube  may  be  made  to  pass  through  the  opening  in 
the  box. 

The  amount  of  air  found  to  be  issuing  up  chimneys 
or  other  outlets  is  a  far  more  reliable  index  of  the  fresh- 
air  supply  than  the  amount  actually  ascertained  to  be 
entering  through  the  inlets ;  and  indeed  the  fresh-air 
supply  can  only  be  fairly  estimated  in  this  way.  As 
already  stated,  the  air  enters  through  every  chink  and 
cranny,  and  in  dry  plastered  walls  may  enter,  to  no 
slight  extent,  through  the  walls  themselves.  Hence  the 
difference  between  the  amount  of  air  found  to  be  entering 
through  the  regular  fresh-air  inlets,  and  that  found  to  be 
issuing  through  the  outlets,  is  often  very  great.  In  a 
ward  containing  15  beds,  with  one  door,  eight  windows, 
and  four  inlets  for  fresh  air,  I  have  found  that  while  only 
880  cubic  feet  of  fresh  air  were  entering  through  the 
inlets  per  bed  per  hour,  as  much  as  3150  were  found  to 
be  issuing  up  the  two  chimneys  and  the  three  extraction- 
flues  of  the  ward.  During  the  experiments  the  door  and 
windows  were,  shut,  and  brisk  fires  kept  burning  in  the 
two  ventilating  fire-places.  The  large  amount,  therefore, 
of  2270  cubic  feet  per  bed  per  hour  entered  through 
chinks  in  the  window-frames,  and  beneath  and  around 


126  EXAMINATION  OF  AIR  AND  VENTILATION. 

the  closed  door.  Very  probably,  in  this  instance,  a  con- 
siderable amount  was  also  drawn,  by  the  extractive  force 
of  the  chimneys  and  flues,  through  the  walls,  inasmuch 
as  they  were  built  of  brick,  and  were  only  whitewashed 
and  not  plastered. 

When  an  examination  of  the  respired  air  itself  is 
intended,  a  suitable  time  must  be  selected,  during  which 
all  the  conditions  of  the  efficiency  of  the  ventilation,  in 
any  given  instance,  can  be  fairly  put  to  the  test.  Take 
a  hospital  ward,  for  example.  It  is  necessary  that  all 
the  beds  should  be  occupied,  that  windows  and  doors  be 
kept  shut,  if  ventilation  is  intended  to  be  effectually 
carried  on  without  them,  and  that  an  hour  should  be 
selected  in  the  night-time  when  the  greatest  accumula- 
tion of  impurities  is  likely  to  occur.  Any  hour  between 
midnight  and  5  A.M.  would  meet  this  condition  in  most 
cases.  In  order  to  make  the  examination  as  complete 
in  detail  as  possible,  it  is  necessary  to  have  a  wet  and 
dry  bulb  thermometer  placed  outside  some  time  previ- 
ously, and  several  others  fixed  at  different  positions  in 
the  ward.  The  outside  and  inside  temperature  can  thus 
be  compared,  and  the  relative  hygometricity  of  the  air 
indoors  and  outdoors  ascertained.  If  the  barometer  is 
read  off  at  the  same  time,  and  the  state  of  the  weather 
recorded,  all  the  meteorological  data  are  obtained  which 
are  usually  considered  necessary  for  a  full  and  exhaustive 
report. 

SECTION  II. — THE  EXAMINATION  OF  THE  CONTAINED 
AIR  BY  THE  SENSES. 

With  a  little  practice,  this  method  of  examination 
gives  tolerably  reliable  results ;  but  it  is  necessary  that 
one  should  remain  for  some  short  time  in  the  open  air, 
before  entering  the  ward  or  room  to  be  examined,  other- 
wise the  sense  of  smell  is  likely  to  be  blunted  and  unable 


EXAMINATION  OF  AIR  AND  VENTILATION.  127 

to  appreciate  the  degree  of  closeness  or  foulness.  One 
of  the  terms,  "  not  close,"  "  rather  close,"  "  close,"  "  very 
close,"  "foul,"  "very  foul  and  offensive,"  will  indicate, 
with  sufficient  accuracy,  the  degree  of  perceptible  impurity 
in  the  majority  of  cases.  The  following  selections  from 
Dr.  de  Chaumont's  experiments  show  how  closely  the 
sensations  accord  with  the  different  degrees  of  impurity 
indicated  by  the  percentage  of  carbonic  acid  : — 

.    f  Extremely  close    At  '0843  per  cent.     Not  very  foul. 
At  '1408  per  cent.  J  -,. 

\andunpleasant.      ,,    '0804       ,,  Close. 

,,   -1090      ,,         Extremely  close,    j  ,,   '0658       ,,  Not  very  close. 

,,   -0962       ,,         Very  close.  j   „    '0568       ,,  Not  close. 

,,   -0921  Close. 


SECTION  III. — CHEMICAL  EXAMINATION. 

1.  Carbonic  Acid. — In  the  chemical  examination  of 
respired  air,  the  chief  point  to  be  determined  is,  the 
amount  of  carbonic  acid  per  1000  volumes.  Petten- 
kofer's  method  is  the  one  most  generally  adopted,  because 
it  is  alike  accurate  and  easy  of  application.  For  the 
analysis,  which  is  volumetric,  French  weights  and  measures 
are  used.  The  following  apparatus  and  solutions  are  also 
required. 

(1.)  Two  or  more  glass  jars,  each  capable  of  holding 
4000  to  6000  centimetre  cubes,  and  fitted  with  india- 
rubber  caps. 

(2.)  A  Mohr's  burette,  graduated  into  centimetre 
cubes  and  tenths,  fitted  with  pinch-cock,  and  large 
enough  to  hold  50  or  100  centimetre  cubes. 

(3.)  A  narrow  glass  measure,  marked  to  measure  30 
and  60  centimetre  cubes  exactly. 

(4.)  A  pair  of  bellows  or  a  bellows-pump. 

(5.)  Turmeric  paper  specially  prepared.  (Turmeric 
powder  should  be  boiled  in  alcohol,  and  ordinary  filtering 
paper  steeped  in  it,  then  washed  and  dried.) 


128  EXAMINATION  OF  AIR  AND  VENTILATION. 

(6.)  Pure  clean  lime  water.  (Both  Dr.  Angus  Smith, 
and  lately  Pettenkofer,  prefer  baryta  water,  but  I  follow 
in  my  description  the  plan  pursued  by  Drs.  Parkes  and 
de  Chaumont,  according  to  which  my  own  analyses  have 
been  made.) 

(7.)  A  solution  of  crystallised  oxalic  acid,  2*25 
grammes  to  the  litre  of  distilled  water. 

The  capacity  of  the  glass  jars  must  be  accurately 
determined  by  means  of  a  litre  measure  graduated  into 
centimetre  cubes,  and  it  is  convenient  to  affix  the  cubic 
contents,  expressed  in  centimetre  cubes,  to  each  jar. 
Before  being  used  it  is  necessary  that  the  jars  should  be 
perfectly  clean  and  dry. 

The  analysis  depends  on  the  relative  degree  of  caus- 
ticity of  the  lime  water  before  and  after  it  has  absorbed 
the  carbonic  acid  contained  in  the  sample  of  air  to  be 
examined.  Thus  1  cubic  centimetre  of  the  above  solu- 
tion of  oxalic  acid  exactly  neutralises  1  milligramme  ('001 
gramme)  of  lime ;  and  hence  the  amount  of  lime  con- 
tained in  a  given  quantity  of  lime  water  can  be  readily 
determined  by  adding  the  solution  until  the  point  of 
neutralisation  is  reached.  The  amount  of  oxalic  acid 
solution  required  for  neutralisation  expresses  the  causticity 
of  the  lime  water.  If  now  the  causticity  of  the  lime 
water  is  known  before  and  after  it  has  absorbed  the 
carbonic  acid  in  the  air  contained  in  the  glass  jar,  the 
difference  will  give  the  amount  of  lime  in  milligrammes 
which  has  united  with  the  carbonic  acid,  and  the  amount 
of  the  latter  is  obtained  by  calculating  according  to  the 
atomic  weights. 

The  amount  of  neutralisation  is  determined  by  means 
of  the  turmeric  paper.  The  test  solution  of  oxalic  acid 
should  be  run  into  the  measured  quantity  of  lime  water 
from  the  burette,  and  the  mixture  constantly  stirred  with 
a  glass  rod.  Every  now  and  again  a  small  drop  of  the 


EXAMINATION  OF  AIR  AND  VENTILATION.  129 

mixture  is  conveyed  on  the  tip  of  the  rod  to  the  turmeric 
paper,  and  one  can  readily  judge  by  the  tint  of  the  stain 
when  the  point  of  neutralisation  is  approached.  With 
pure  lime  water  the  stain  produced  is  an  intense  dark 
brown,  and  as  the  oxalic  acid  solution  is  added,  it  becomes 
gradually  paler  on  each  application,  until  at  last  the 
centre  of  the  stain  is  not  tinted,  and  the  margin  alone 
appears  as  a  delicate  brown  ring.  The  solution  should 
now  be  carefully  added  drop  by  drop,  and  when  the  tint 
of  the  ring  also  disappears,  the  point  of  neutralisation  has 
been  reached. 

In  making  a  single  analysis  it  is  advisable  to  use 
two  jars,  because  otherwise  a  repetition  of  the  experiment 
would  not  be  possible  were  it  required.  Under  ordinary 
circumstances,  however,  as  many  analyses  can  be  made  as 
there  are  jars  used  for  collecting  samples  of  the  air  from 
different  parts  of  the  same  room  or  building.  The  air  to 
be  examined  is  forced  into  the  jars  by  means  of  a  pair  of 
bellows,  and,  by  a  suitable  arrangement  of  tubing  con- 
nected with  the  bellows,  it  can  be  pumped  into  them 
from  any  part  of  the  room.  In  the  case  of  small  occupied 
spaces,  such  as  prison-cells,  when  it  is  not  desirable  to 
disturb  the  ventilation  by  opening  the  door,  the  contained 
air  can  in  this  way  be  pumped  into  the  jars  through  any 
opening,  such  as  the  inspection  hole  in  the  door, — care 
being  taken  that  the  tubing  and  its  connection  with  the 
bellows  are  perfectly  air-tight,  and  that  the  bellows-valve 
acts  efficiently. 

Instead  of  bellows,  a  bellows-pump  may  be  used,  but 
in  either  case  the  nozzle  should  be  long  enough  to  reach 
the  bottom  of  the  jar.  Dr.  Angus  Smith  prefers  using 
the  bellows-pump,  exhausting  the  air  in  the  jar,  and  thus 
ensuring  that  its  place  shall  be  taken  by  the  air  to  be 
examined.  Pettenkofer  and  Dr.  -  de  Chaumont,  on  the 
other  hand,  pump  the  air  into  the  jar  ;  but  either  method 

K 


130  EXAMINATION  OF  AIR  AND  VENTILATION. 

answers  very  well,  provided  that  care  be  taken  that  the 
jar  is  really  rilled  with  the  air  to  be  examined. 

After  the  jar  has  been  filled,  60  cubic  centimetres  of 
lime  water  are  introduced,  and  the  mouth  of  the  jar  closed 
by  a  tight-fitting  india-rubber  cap.  If  tubing  has  been 
used  to  convey  the  air  from  a  distant  part  of  the  room,  or 
from  a  small  inhabited  place  without  entering  it,  it  is 
necessary  that  this  part  of  the  experiment  should  be 
performed  rapidly,  in  order  to  prevent  escape  by  diffusion, 
and  therefore  the  measured  quantity  of  lime  water  should 
be  ready  to  be  poured  into  the  jar  whenever  the  nozzle 
of  the  bellows  is  withdrawn.  The  jar  is  then  well  shaken, 
so  that  the  lime  water  is  made  to  wash  the  contained  air 
thoroughly,  and  afterwards  is  left  to  stand  for  a  period  of 
not  less  than  six  or  eight  hours,  and  not  more  than 
twenty-four.  60  cubic  centimetres  are  introduced,  in 
order  that  30  may  be  taken  out  for  analysis.  So  much 
of  the  lime  water  adheres  to  the  sides  of  the  jar  that  the 
whole  amount  introduced  cannot  be  poured  out ;  and 
hence,  if  a  repetition  of  the  experiment  is  necessary, 
another  jar  must  be  used. 

In  making  the  analysis,  30  cubic  centimetres  of  the 
lime  water  which  has  been  employed  are  poured  into  a 
mixing  jar,  and  its  causticity  determined  as  above  de- 
scribed by  the  test  solution.  Then  30  cubic  centimetres 
are  taken  from  the  jar,  and  the  causticity  also  determined. 
The  causticity  of  the  lime  water  is  found  to  vary  from 
34  to  41,  according  to  its  strength:  in  other  words,  from 
34  to  41  cubic  centimetres  of  the  oxalic  acid  solution  will 
be  required  for  neutralisation,  while  the  causticity  of  the 
lime  water  in  the  jar  will  be  lessened  in  proportion  to  the 
amount  of  carbonic  acid  in  the  contained  air.  The  differ- 
ence between  the  first  and  second  operations  is  doubled 
to  account  for  the  30  cubic  centimetres  left  in  the  jar, 
and  the  product  gives  the  amount  of  lime  which  has  com- 


EXAMINATION  OF  AIR  AND  VENTILATION.  131 

bined  with  the  carbonic  acid.  The  amount  of  the  latter, 
as  already  observed,  is  obtained  by  converting  weight  into 
measure  according  to  the  atomic  weights,  and  in  one 
sum  tbe  factor  is  found  to  be  '39521.  The  capacity  of 
the  jar  being  known,  and  a  deduction  of  60  cubic  centi- 
metres made  for  the  space  occupied  by  the  lime  water, 
the  amount  of  carbonic  acid  becomes  a  question  of  simple 
proportion.  Thus,  to  take  an  example — Suppose  the 
causticity  of  30  cubic  centimetres  of  the  lime  water  is 
39'5,  and  the  causticity  of  the  lime  water  in  the  jar  is 
3 3 '5  ;  suppose  also  that  the  capacity  of  the  jar  is  5060 
cubic  centimetres ;  then,  to  find  the  ratio  of  carbonic  acid 
per  1000  volumes,  that  is  per  1000  cubic  centimetres, 
the  problem  is  as  follows  : — 

(5060-60)  :1000::[(39-5-33-5)x2x'3952l]  :X 
therefore  X  =  ^p^=-948  carbonic  acid  per  1000 
volumes. 

It  will  thus  be  seen  that  the  calculations  may  be 
simplified  by  adopting  the  following  rule : — Multiply  the 
difference  between  the  causticity  of  the  lime  water,  before 
and  after  it  has  been  placed  in  the  jar,  by  790,  and  divide 
this  sum  by  the  number  of  centimetre  cubes  contained  by 
the  jar,  minus  60.  The  result  will  be  the  ratio  of  car- 
bonic acid  per  1000  volumes. 

But  a  certain  correction  must  be  made  for  tempera- 
ture, according  as  it  is  above  or  below  the  standard  of 
62°  Fahr.  As  the  co-efficient  of  expansion  of  air  is 
•0020361  for  every  degree  Fahr.,  the  rule  for  correction 
may  be  stated  with  sufficient  accuracy  thus : — For  every 
5°  above  62°  add  1  per  cent  to  the  amount  of  carbonic 
acid  calculated  as  above,  and  deduct  the  same  percentage 
for  every  5°  below  62°. 

If  the  place  of  observation  is  much  above  the  sea- 
level,  a  correction  must  also  be  made  for  the  difference  of 
atmospheric  pressure.  The  standard  barometric  pressure 
being  30,  the  formula  for  this  correction  is  as  follows :— 


132 


EXAMINATION  OF  AIR  AND  VENTILATION. 


3  0  :  (observed  height  of  barometer)  : :  capacity  of  jar  :  Z. 
The  result  expressed  by  Z  is  substituted  for  the  actual 
capacity  of  the  jar  in  the  calculation  for  carbonic  acid. 

Amongst  various  popular  tests  for  the  estimation  of 
the  carbonic  acid  in  air  vitiated  by  respiration,  the  follow- 
ing, proposed  by  Dr^_Ajigu£  JSDaith,  is  worthy  of  notice, 
because  it  does  not  require  skilled  manipulation,  nor  is  it 
hampered  with  troublesome  measurements  or  calculations. 
The  method  is  based  upon  the  fact  that  the  amount  of 
carbonic  acid  in  a  given  quantity  of  air  will  not  produce 
a  precipitate  in  a  certain  given  quantity  of  lime  water, 
unless  the  carbonic  acid  is  in  excess.  This  will  be  better 
understood  by  comparing  the  different  columns  in  the 
subjoined  table,  which  is  taken  from  Dr.  Smith's  work  on 
Air  and  Rain  : — 


EASIEST  PROPOSED  HOUSEHOLD  METHOD. 

TABLE. — To  be  used  when  the  point  of  observation  is  "  No  pre- 
cipitate." Half  an  ounce  of  lime  water  containing  *0195 
gramme  lime. 

Air  at  0°  C.  and  760  Millim's  bar. 


Carbonic  acid 
in  the  air. 
Per  cent. 

Volume  of  air 
in  cubic 
centimetres. 

Size  of  bottle 
in  cubic 
centimetres. 

Size  of  bottle 
in  ounces 
avoirdupois. 

•03 

571 

584 

20-63 

•04 

428 

443 

15-60 

•05 

342 

356 

12-58 

•06 

285 

299 

10-57 

•07 

245 

259 

9-13 

•08 

214 

228 

8-05 

•09 

190 

204 

7-21 

•10 

171 

185 

6-54 

•11 

156 

170 

6-00 

•12 

143 

157 

5-53 

•13 

132 

146 

5-15 

•14 

123 

137 

4-82 

•15 

114 

128 

4-53 

•20 

86 

100 

3-52 

•25 

69 

83 

2-92 

•30 

57 

71 

2-51 

EXAMINATION  OF  AIR  AND  VENTILATION.  133 

Columns  1  and  2  give  the  ratio  of  carbonic  acid  in 
the  quantity  of  air  which  will  produce  no  precipitate  in 
half  an  ounce  lime  water;  column  3  is  the  same  as 
column  2,  with  the  addition  of  14' 16  cubic  centimetres, 
or  half  an  ounce,  to  give  the  corresponding  size  of  bottle  ; 
and  column  4  gives  the  size  of  bottle  in  ounces  avoir- 
dupois. It  will  thus  be  seen  that  different-sized  bottles 
containing  half  an  ounce  of  lime  water  will  indicate  ap- 
proximately the  ratio  of  carbonic  acid  in  the  air  contained 
in  them,  by  giving  no  precipitate  when  the  bottle  is  well 
shaken.  Thus,  if  a  bottle  of  1 0£  oz.  is  used,  and  there 
is  no  precipitate,  it  will  indicate  that  the  ratio  of  carbonic 
acid  does  not  exceed  '06  per  cent;  or  if  one  of  8  oz.  is 
used,  and  there  is  also  no  precipitate,  it  will  indicate  that 
the  ratio  does  not  exceed  "08,  and  so  on.  Dr.  Smith  says 
that  "  the  lime  wrater  may  be  prepared  of  the  same  con- 
stant strength  so  closely  that  we  may  neglect  the  differ- 
ence. Burnt  lime  is  slaked  with  water  and  dissolved  by 
shaking.  It  is  then  kept  in  a  bottle  to  stand  till  it  is 
clear.  The  bottle  or  bottles  used  should  be  wide-mouthed, 
so  that  they  can  be  readily  cleaned  and  dried,  and  the  air 
to  be  examined  may  be  made  to  enter  them  by  inhaling 
the  air  contained  in  them  through  a  glass  or  caoutchouc 
tube,  care  being  taken  not  to  breathe  into  the  bottle." 

As  a  practical  application  of  this  method,  which  can 
be  practised  by  any  one,  Dr.  Smith  proposes  the  following 
rule  : — "  Let  us  keep  our  rooms  so  that  the  air  gives  no 
precipitate  when  a  10^  oz.  bottleful  is  shaken  with  half 
an  ounce  of  clear  lime  water." 

2.  Organic  Impurities. — To  obtain  an  approximate 
estimate  of  the  organic  impurities,  the  air  may  be  drawn 
through,  or  washed,  in  a  very  dilute  solution  of  potassium 
permanganate  of  known  strength.  The  result  is  stated  in 
the  number  of  cubic  feet  of  air  which  it  takes  to  decolourise 
•001  gramme  of  the  potassium  permanganate  in  solution. 


134  EXAMINATION  OF  AIR  AND  VENTILATION. 

The  method  pursued  by  Dr.  Angus  Smith  is  somewhat 
different  from  this.  He  takes  about  3  0  cubic  centimetres 
of  -pure  water,  and  adds  to  it  a  small  amount  of  known 
solution  of  the  potassium  permanganate.  This  solution 
is  shaken  up  with  the  air  in  the  bottle ;  the  air  is  then 
drawn  out  by  a  bellows-pump,  and  another  bottleful 
washed,  and  so  on  until  the  whole  colour  is  removed,  or 
a  sufficient  amount  to  enable  him  to  test  the  remainder, 
so  as  to  be  able  to  estimate  the  difference.  The  actual 
amount  of  oxygen  taken  is  then  calculated,  and  the  results 
stated  in  grains  per  million  cubic  feet  of  air. 

3.  Ammonia. — The  estimation  of  the  ammonia,  organic 
and  albuminoid,  is  a  still  more  delicate  and  difficult  pro- 
cess. The  water  used  for  washing  the  air  must  be  per- 
fectly pure,  and  should  therefore  be  boiled  with  soda  or 
potash  before  distillation.  From  30  to  50  cubic  centi- 
metres are  then  introduced  into  a  bottle  of  about  2000 
cubic  centimetres,  and  the  washing  of  successive  bottlefuls 
of  the  air  to  be  examined  is  continued  until  the  water  is 
sufficiently  charged  with  impurities.  A  more  exact  method 
is  to  draw  the  air  through*  distilled  water  by  means  of  an 
aspirator  of  known  dimensions,  which,  whether  charged 
once  or  several  times,  will  indicate  accurately  the  amount 
of  air  whose  impurities  are  to  be  tested.  The  testing 
afterwards  is  the  same  as  that  proposed  by  Messrs. 
Wanklyn,  Chapman,  and  Smith,  for  organic  impurities  in 
water,  and  the  results  are  stated  in  grains  per  million 
cubic  feet  of  air. 

For  further  information  concerning  these  methods  of 
analysis,  and  for  an  account  of  numerous  valuable  experi- 
ments, see  Dr.  Angus  Smith's  work  already  quoted,  and 
Dr.  Fox's  work  on  the  Sanitary  Examinations  of  Water, 
Air,  and  Food. 


EXAMINATION  OF  AIE  AND  VENTILATION.  135 


SECTION  IV. — MICROSCOPICAL  EXAMINATION. 

Suspended  matters  contained  in  the  air  may  be  col- 
lected by  drawing  the  air  through  distilled  water  by  means 
of  an  aspirator,  by  washing  the  air  in  distilled  water,  or 
by  employing  an  instrument  called  an  aeroscope.  When 
either  of  the  first  two  processes  is  employed,  the  suspended 
matters  are  merely  allowed  to  subside,  and  are  then 
removed  to  a  glass  slip  for  examination.  The  aeroscope 
invented  by  Pouchet  consists  of  a  funnel-shaped  tube, 
ending  in  a  fine  point,  beneath  which  is  placed  a  slip  of 
glass  moistened  with  glycerine.  Both  glass  and  tube  are 
enclosed  in  an  air-tight  chamber,  which  is  connected  by 
tubing  with  an  aspirator,  so  that  when  the  stopcock  of  the 
aspirator  is  turned,  and  the  water  allowed  to  escape,  the 
air  is  drawn  through  the  tube,  and  impinges  against  the 
slip  of  glass  moistened  with  glycerine,  by  which  the 
suspended  matters  are  arrested. 

SECTION  V. — EXAMINATION  AS  REGARDS  TEMPERATURE 
AND  MOISTURE. 

1.  Temperature. — The  various  points  connected  with 
the  temperature  of  the  contained  air,  such  as  its  equability, 
sufficiency,  etc.,  are  readily  ascertained  by  a  judicious  dis- 
tribution of  thermometers   throughout   the   space  to  be 
examined,  and  by  comparing  the  outside  with  the  inside 
temperature.     The  efficiency  of  the  heating  apparatus  is 
of  course  best  tested  during  very  cold  weather  and  in  the 
night  time.     When  open  fire-places  are  used  the  tempera- 
ture should  be  noted  at  the  remote  parts  of  the  room,  and 
if  the  air  is  heated  before  entering,  it  is  advisable  to  takex 
the  temperature  at  the  point  of  delivery,  and  to  ascertain 
whether  it  is  well  diffused  or  not. 

2.  Moisture. — The  amount  of  watery  vapour,  or  the 


136  EXAMINATION  OF  AIR  AND  VENTILATION. 

hygrometricity  of  the  contained  air,  may  be  determined 
by  hygrometers  such  as  Daniell's  and  Eegnault's,  or  by 
wet  and  dry  bulb  thermometers.  The  latter  are  the  most 
convenient  and  reliable,  but  they  should  be  distributed 
some  two  or  three  hours  before  the  observations  are  made. 
The  wet  bulb  is  covered  with  muslin,  over  which  there 
is  twisted  a  small  skein  of  cotton,  which  dips  into  a  little 
vessel  containing  either  distilled  or  rain  water.  The 
cotton  should  be  boiled  in  ether,  or  soaked  in  a  solution 
of  sodium  carbonate,  to  free  it  from  fat,  so  that  the  water 
may  readily  ascend  by  the  force  of  capillary  attraction. 

Unless  the  air  is  saturated  with  moisture,  the  tem- 
perature of  the  wet  bulb  is  always  below  the  temperature 
of  the  dry,  and  the  number  of  degrees  of  difference  be- 
tween them  varies  according  to  the  amount  of  watery 
vapour  present.  This  is  generally  represented  in  relative 
terms.  For  example,  the  point  of  complete  saturation 
being  assumed  to  be  100,  any  degree  of  dryness  may  be 
stated  as  a  percentage  of  this,  and  can  be  conveniently 
ascertained  by  reference  to  the  table  given  on  the  opposite 
page,  which  has  been  calculated  from  Mr.  Glaisher's  large 
tables.  The  table  is  read  by  taking  the  temperature  of 
the  dry  bulb,  and  the  difference  between  it  and  that  of 
the  wet  bulb,  and  noting  the  number  given  at  the  inter- 
section of  the  two  columns.  This  number  gives  the 
relative  humidity. 

The  relative  humidity  of  the  air  out  of  doors  should 
also  be  ascertained  at  the  same  time,  by  way  of  com- 
parison. 

In  carrying  out  experiments  in  ventilation,  thejiajr- 
hygrometer  gives  sufficiently  accurate  results,  and  possesses 
a  considerable  advantage  over  the  dry  and  wet  bulb  ther- 
mometer in  rapidity  of  indication.  It  consists  of  a  human 
hair  freed  from  fat  by  steeping  it  in  ether  or  a  solution 
of  liquor  potassse,  one  end  of  which  is  fixed,  and  the  other 


TABLE  of  the  Relative  Humidity  given  by  the  difference 
between  the  Dry  and  Wet  Bulb. 


137 


=  —  ' 
•8  Ss 
|£pq 

S*& 
1  fi 

DIFFERENCE  BETWEEN  THE  DRY  AND  WET  BULB. 

0 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

RELATIVE  HUMIDITY,  SATURATION  =  100. 

90 

100 

95 

90 

85 

81 

77 

73 

69 

65 

62 

59 

56 

53 

50 

47 

44 

89 

100 

95 

90 

85 

81 

77 

73 

69 

65 

01 

58 

55 

52 

49 

46 

43 

88 

100 

95 

90 

85 

81 

77 

73 

69 

65 

01 

58 

55 

52 

49 

46 

43 

87 

100 

96 

90 

85 

81 

77 

73 

69 

65 

61 

58 

55 

52 

49 

46 

43 

86 

100 

95 

90 

85 

80 

76 

72 

68 

64 

61 

58 

55 

52 

49 

46 

43 

85 

100 

95 

•JO 

85 

80 

76 

72 

68 

64 

61 

58 

55 

52 

49 

46 

43 

84 

100 

95 

90 

85 

80 

70 

72 

68 

64 

60 

57 

54 

51 

48 

45 

43 

83 

100 

95 

90 

85 

80 

70 

72 

68 

64 

60 

57 

54 

51 

48 

45 

42 

82 

100 

95 

90 

85 

80 

70 

72 

68 

64 

60 

57 

54 

51 

48 

45 

42 

81 

100 

95 

90 

85 

80 

76 

72 

68 

64 

60 

56 

53 

50 

47 

44 

41 

80 

100 

95 

90 

85 

80 

75 

71 

67 

63 

59 

56 

53 

50 

47 

44 

41 

79 

100 

95 

90 

85 

80 

75 

71 

67 

63 

59 

56 

53 

50 

47 

44 

41 

78 

100 

94 

89 

84 

79 

75 

71 

67 

63 

59 

56 

53 

50 

47 

44 

41 

77 

100 

94 

89 

84 

79 

75 

71 

67 

63 

59 

56 

53 

50 

47 

44 

41 

76 

100 

94 

89 

84 

79 

75 

71 

67 

63 

59 

55 

52 

49 

46 

43 

40 

75 

100 

94 

89 

84 

79 

74 

70 

66 

62 

58 

55 

52 

49 

40 

43 

40 

74 

100 

94 

89 

84 

79 

74 

70 

66 

62 

58 

55 

52 

48 

45 

43 

40 

73 

100 

94 

89 

84 

79 

74 

70 

66 

62 

58 

54 

51 

48 

45 

42 

40 

7'2 

100 

94 

89 

84 

79 

74 

69 

65 

61 

57 

54 

51 

48 

45 

42 

39 

71 

100 

94 

88 

83 

78 

73 

69 

65 

61 

57 

53 

50 

47 

44 

41 

38 

70 

100 

94 

88 

83 

78 

73 

69 

65 

61 

57 

53 

50 

47 

44 

41 

38 

69 

100 

94 

88 

83 

78 

73 

68 

64 

60 

56 

53 

50 

47 

44 

41 

38 

68 

100 

94 

88 

83 

78 

73 

68 

64 

60 

56 

52 

49 

46 

43 

40 

37 

67 

100 

94 

88 

83 

7S 

73 

68 

64 

60 

56 

52 

49 

46 

43 

40 

37 

06 

100 

94 

88 

83 

78 

73 

68 

64 

60 

56 

52 

48 

45 

42 

40 

37 

65 

100 

94 

88 

83 

78 

73 

68 

63 

59 

55 

51 

48 

45 

42 

39 

36 

04 

100 

94 

88 

82 

77 

72 

67 

63 

59 

55 

51 

48 

45 

42 

39 

36 

03 

100 

94 

88 

82 

77 

72 

07 

63 

59 

55 

51 

47 

44 

41 

38 

35 

62 

100 

94 

b^ 

82 

77 

72 

67 

62 

66 

55 

50 

47 

44 

41 

38 

35 

61 

100 

94 

88 

82 

77 

72 

67 

62 

58 

54 

50 

47 

44 

41 

38 

35 

60 

100 

94 

BS 

82 

76 

71 

66 

62 

58 

54 

50 

46 

43 

40 

37 

34 

59 

100 

94 

88 

82 

76 

71 

66 

61 

57 

53 

49 

46 

43 

40 

37 

34 

58 

100 

93 

67 

81 

76 

71 

66 

61 

57 

53 

49 

46 

43 

40 

37 

34 

57 

100 

93 

87 

81 

75 

70 

65 

61 

57 

53 

49 

45 

42 

39 

36 

33 

56 

100 

93 

87 

81 

75 

70 

65 

60 

56 

52 

48 

44 

41 

38 

35 

32 

55 

100 

93 

87 

81 

75 

70 

65 

60 

56 

52 

48 

44 

41 

38 

35 

32 

54 

100 

93 

86 

80 

74 

69 

64 

59 

55 

51 

47 

43 

40 

37 

34 

31 

53 

100 

93 

86 

80 

74 

69 

64 

59 

55 

51 

47 

43 

39 

36 

33 

30 

52 

100 

93 

80 

80 

74 

69 

64 

59 

54 

50 

46 

42 

39 

36 

33 

30 

51 

100 

93 

86 

80 

74 

68 

63 

58 

54 

50 

46 

42 

38 

35 

32 

29 

50 

100 

93 

86 

80 

74 

68 

63 

58 

53 

49 

45 

41 

37 

34 

31 

29 

49 

100 

93 

86 

79 

73 

07 

62 

57 

53 

49 

45 

41 

37 

34 

31 

28 

48 

100 

93 

86 

79 

73 

67 

62 

57 

52 

48 

44 

40 

36 

33 

30 

47 

100 

93 

86 

79 

73 

07 

61 

56 

51 

47 

43 

39 

36 

33 

30 

46 

100 

93 

86 

79 

73 

07 

61 

56 

51 

47 

43 

39 

35 

32 

29 

45 

100 

92 

85 

78 

72 

66 

60 

55 

50 

46 

42 

38 

34 

31 

28 

44 

100 

92 

84 

78 

71 

65 

59 

54 

49 

45 

41 

37 

34 

31 

28 

43 

100 

92 

84 

78 

71 

65 

59 

54 

49 

45 

41 

37 

34 

31 

28 

42 

100 

92 

84 

78 

71 

64 

59 

54 

49 

44 

40 

36 

34 

30 

27 

41 

100 

92 

84 

77 

70 

64 

58 

53 

M 

43 

39 

35 

31 

28 

40 

100 

92 

84 

77 

69 

03 

57 

52 

47 

42 

38 

34 

31 

39 

100 

92 

84 

77 

69 

57 

51 

46 

42 

38 

34 

38 

100 

91 

83 

75 

68 

62 

56 

50 

45 

41 

37 

37 

100 

91 

83 

75 

68 

01 

55 

49 

44 

39 

36 

100 

91 

82 

74 

66 

59 

53 

47 

42 

35 

100 

90 

80 

72 

34 

100 

89 

79 

72 

33 

100 

89 

78 

70 

100 

87 

75 

138  EXAMINATION  OF  AIR  AND  VENTILATION. 

attached  to  a  small  needle,  and  according  as  the  hair 
becomes  shorter  or  elongates,  the  needle  traverses  a  gradu- 
ated scale,  and  thus  indicates  the  relative  humidity. 
After  a  time,  however,  it  loses  its  delicacy,  and  requires 
to  be  readjusted. 

In  a  room  well  ventilated  and  warmed  the  humidity 
ought  to  range  between  73  and  75  per  cent,  the  tem- 
perature should  not  fall  below  60°  Fahr.,  and  the  car- 
bonic acid,  as  previously  stated,  should  not  exceed  *6  per 
1000  volumes. 

In  the  examination  of  the  air  contained  in  the  crowded 
dwellings  of  the  poorer  classes,  the  senses  will  alone  suffi- 
ciently indicate  the  degree  of  impurity,  but  in  all  cases 
the  cubic  space  per  head,  and  the  means  of  ventilation, 
should  be  carefully  noted,  because  otherwise  any  sugges- 
tions as  regards  improvements  will  at  the  best  be  hap- 
hazard, and  possibly  ill-advised.  The  amount  of  cubic 
space  obtainable  in  the  houses  of  the  poor,  and  especially 
in  rural  districts,  will  be  more  fully  discussed  in  Chapters 
IX,  and  XVI. 


WATER.  139 


CHAPTER  VI. 

WATER. 

SECTION  I. — SOURCES. 

ALL  supplies  of  fresh  water  are  derived  from  the  con- 
densation of  the  aqueous  vapour  contained  in  the 
atmosphere.  Whether  this  falls  to  the  earth  in  the  form 
of  rain  or  snow,  a  certain  portion  of  it  runs  off  the  sur- 
face and  gravitates  towards  the  sea ;  another  portion  sinks 
into  the  soil,  and,  passing  through  strata  which  are  more 
or  less  porous,  or  through  fissures  in  rocks,  again  reappears 
in  springs  and  wells ;  a  third  portion  is  evaporated  where 
it  falls;  and  the  remainder  becomes  absorbed  in  the 
chemical  composition  of  minerals,  or  is  utilised  in  the  pro- 
cesses of  growth  and  decay  of  animal  and  vegetable  life. 

The  rainfall  which  flows  on  the  surface  collects  in 
streams,  lakes,  and  rivers,  according  to  the  conformation 
of  the  ground,  while  the  water  flowing  under  ground  oozes 
to  the  surface  either  imperceptibly  or  in  springs,  and 
eventually  unites  with  the  surface  water  in  its  accumula- 
tion in  lakes,  or  in  its  onward  progress  towards  the  sea. 

The  immediate  sources  of  water-supply  may  therefore 
be  classified  as  rain  water  and  water  from  springs,  wells, 
rivers,  or  lakes. 

1.  Rain  Water. — Rain  Water  is  highly  aerated,  and, 
when  uncontaminated  by  the  receiving  surface  or  by  air- 
impurities',  is  healthy  and  pleasant.  But  frequently, 


140  WATER. 

according  to  the  analyses  of  the  Elvers  Pollution  Com- 
missioners, it  contains  a  large  amount  of  organic  matter, 
and  in  this  country  is  usually  far  less  pure  than  water 
derived  from  deep  wells  and  springs.  This  is  not  to  be 
wondered  at,  when  we  consider  that  the  atmosphere  in 
a  thickly  populated  country  like  Great  Britain  becomes 
the  recipient  of  vast  quantities  of  excremental  dust  and 
effluvia,  of  smoke  particles,  and  the  products  of  animal 
and  vegetable  decay.  It  is,  therefore,  seldom  stored  on 
premises  except  for  washing  purposes,  but  in  Venice  and 
many  other  continental  cities  it  is  collected  in  underground 
reservoirs,  and  constitutes  almost  the  sole  source  of  fresh- 
water supply  to  the  inhabitants.  It  is  usually  collected 
from  the  roofs  of  houses,  and  occasionally  from  paved  or 
cemented  ground.  In  hilly  districts  with  deep  ravines,  it 
may  be  stored  by  carrying  an  embankment  across  a  valley, 
or,  in  level  districts,  by  digging  a  series  of  open  trenches 
leading  to  a  tank  or  reservoir. 

The  amount  of  water  derivable  from  the  rainfall  in 
given  cases  is  readily  ascertained,  if  the  mean  annual 
rainfall  of  the  district  is  known,  and  the  dimensions  of 
the  receiving  area  are  obtained.  Thus,  when  the  roofs  of 
houses  constitute  the  receiving  area,  the  transverse  section 
of  the  buildings  will  be  one  factor,  and  the  mean  annual 
rainfall  the  other.  It  has  been  estimated  that  the  quan- 
tity which  can  be  collected  from  the  roof  surface  of  any 
town  in  this  country  will  scarcely  amount  to  2  gallons 
per  inhabitant  daily,  assuming  that  the  average  rainfall 
is  20  inches,  and  that  house  accommodation  gives  a  roof 
area  of  60  square  feet  for  each  individual. 

If  lines  be  drawn  through  the  sources  of  the  tribu- 
taries of  rivers  marked  on  a  map,  they  will  be  found  to 
form  the  boundaries  of  certain  areas  which  are  called  the 
catchment  basins  of  the  various  rivers — that  is,  the  areas 
which  receive  the  rainfall  supplying  their  waters.  In 


WATER.  141 

compact  formations,  where  most  of  the  rain  runs  off  the 
surface,  the  ridge  lines  bounding  these  basins  usually  pass 
along  the  most  elevated  regions,  but  in  porous  formations 
their  course  will  depend  on  the  configuration  of  the  reten- 
tive substratum. 

The  amount  of  rainfall  which  penetrates  beneath  the 
surface  varies  according  to  the  density  and  configuration 
of  the  ground,  and  also  depends  on  whatever  influences  /  / 
the  rate  of  evaporation.  Thus  in  loose  sandy  or  gravelly 
districts  as  much  as  90  to  96  per  cent  sinks  into  the 
soil;  in  chalk  districts,  42  ;  in  limestone,  20;  while  in 
districts  of  retentive,  impermeable  clay,  the  percentage  is 
very  small.  Dr.  Dalton,  in  his  experiments  on  the  new 
red  sandstone  soil  of  Manchester,  found  that  2  5  per  cent 
of  the  whole  rainfall  penetrated  to  the  depth  of  3  feet ; 
and  Mr.  Prestwich  gave  the  amount  of  infiltration  of  the 
principal  water-bearing  strata  surrounding  London  as  vary-  . 
ing  from  48  to  60  per  cent. 

Other  things  being  equal,  the  amount  of  infiltration 
will  be  far  less  in  an  undulating  hilly  district  than  in 
open,  level  plains.  It  is  obvious  also  that  it  must  vary 
very  considerably  with  the  season  of  the  year.  Thus, 
according  to  the  experiments  of  Mr.  Dickinson,  made  in 
the  gravelly  loam  which  covers  the  chalk  in  the  valleys 
around  Watford,  it  was  70  per  cent  in  the  first  three 
months  of  the  year ;  in  the  summer  months  it  was  only 
2  ;  while  in  November  and  December  nearly  the  whole 
of  the  rainfall  penetrated  beneath  the  surface. 

2.  Water  from  Wells,  Springs,  Rivers,  and  Lakes. — 
The  quality  and  composition  of  the  water  derived  from 
these  sources  depend  on  the  nature  of  the  soil  and  geolo- 
gical strata  through  which  it  has  passed,  or  on  the 
character  of  its  surface-bed  or  channel.  The  rain,  already 
charged  with  carbonic  acid  in  its  passage  through  the 
lower  regions  of  the  atmosphere,  becomes  still  more 


142  WATER. 

largely  impregnated  with  this  gas  when  it  sinks  beneath 
the  surface.  In  some  rich  soils,  the  amount  present  in 
the  air  contained  within  their  interstices,  according  to 
Boussinganlt,  is  250  times  greater  than  the  ordinary 
atmospheric  ratio.  Aided  by  the  action  of  the  carbonic 
acid  which  it  has  thus  absorbed,  the  rain  water  dissolves 
and  decomposes  various  chemical  compounds  which  it 
meets  "with  in  its  underground  progress,  and  often  be- 
comes so  highly  charged  with  them  as  to  become  unfit 
for  ordinary  use,  as  in  the  case  of  mineral  waters. 

(1.)  Surface  or  shallow-well  waters,  though  some- 
times comparatively  pure,  frequently  contain  a  large 
amount  of  organic  matter.  In  mossy  moorland  districts, 
for  example,  or  in  rich  vegetable  soils,  the  water  may 
contain  from  12  to  30  grains  of  vegetable  matter  per 
gallon,  which  imparts  to  it  a  yellowish  or  brownish  tint ; 
while  in  marshy  districts  the  amount  of  organic  matter 
varies  from  10  to  100  grains.  The  saline  constituents 
depend  very  much  upon  the  geological  character  of  the 
stratum  in  or  upon  which  the  well  is  sunk,  but  in  in- 
habited places  these  are  often  masked  by  the  products  of 
excremental  pollution.  Shallow-well  waters  are  drawn 
from  wells  not  more  than  50  feet  deep,  and  seldom  ex- 
ceeding half  that  depth.  Surface  waters  from  cultivated 
land  are  always  more  or  less  contaminated  with  manurial 
impurities,  and  should  therefore  be  efficiently  filtered 
before  being  used. 

(2.)  The  water  from  deep  wells  and  springs  varies 
according  to  the  geological  strata  through  which  it  passes. 
Thus  alluvial  waters  are  more  or  less  impure,  containing 
a  large  amount  of  salts  (20  to  120  grains  per  gallon), 
and  often  much  organic  matter ;  while  the  chalk  waters 
are  clear,  wholesome,  and  sparkling,  holding  in  solution 
a  considerable  amount  of  calcium  carbonate  besides  other 
salts,  and  being  largely  impregnated  with  carbonic  acid. 


WATER.-  143 

Also  wholesome  and  agreeable  to  the  taste,  but  not  so 
suitable  for  cooking  purposes,  is  the  water  from  the  lime- 
stone and  magnesian  limestone  strata.  It  contains  more 
calcium  and  magnesium  sulphate  than  the  chalk  water, 
and  consequently  does  not  become  so  soft  on  boiling. 
Waters  from  the  granitic,  metamorphic,  trap -rock,  and 
clay-slate  formations,  are  generally  very  pure,  and  con- 
tain but  small  quantities  of  solids,  consisting  chiefly  of 
sodium  carbonate  and  chloride,  with  a  little  lime  and 
magnesia.  Waters  from  the  millstone  grit  and  hard  oolite 
are  also  very  pure.  The  saline  constituents  are  by  no 
means  excessive,  and  are  chiefly  in  the  form  of  calcium 
and  magnesium  sulphate  and  carbonate,  with  traces  of 
iron.  Soft  sand -rock  waters,  loose  sand  and  gravel 
waters,  and  waters  from  the  lias  clays,  vary  very  much 
in  quality  and  composition,  some  of  them  being  very 
pure,  as  the  Farnham  waters,  and  others  containing  large 
amounts  of  mineral  and  organic  matters. 

(3.)  River  water  is  in  most  cases  softer  than  spring  or 
well  water.  It  contains  a  smaller  amount  of  mineral 
salts,  but  is  often  largely  impregnated  with  organic  matter 
on  account  of  the  vegetable  ddbris  and  animal  excreta 
which  find  their  way  into  it.  Its  constant  movement, 
however,  facilitates  the  oxidation  of  organic  impurities, 
and  this  purifying  process  is  aided  to  some  extent  by  the 
presence  of  fresh-water  plants. 

(4.)  Lake  water,  especially  in  mountainous  districts 
composed  of  the  older  rock  formations,  is  generally  very 
soft,  containing  little  mineral  matter ;  but  as  it  is  essen- 
tially a  stagnant  water,  and  as  all  lakes  receive  the  wash- 
ings of  the  districts  in  which  they  are  situated,  the  amount 
of  organic  nitrogenous  matter  is  sometimes  very  consider- 
able. Any  excess,  however,  of  peaty  matter  in  solution 
may  be  materially  lessened  by  filtering  through  sand. 

As  regards  the  qualities  of  potable  waters  founded 


1 44  WATER. 

upon  their  respective  sources,  the  following  classifications 
are  given  by  the  Kivers  Pollution  Commissioners  in  their 
Sixth  Eeport : — 

I.   In    respect    of    wholesomeness,    palatability,    and 
general  fitness  for  drinking  and  cooking : — 

1.  Spring  water.  1      ,r 

,IT1    ,  h     Very  palatable. 

Wholesome.    -{  2.  Deep-well  water. 

3.  Upland  surface  water.  "I          Moderately 

4.  Stored  rain  water.  /          palatable. 


f  4.  Stored  ram  water. 

Suspicious.     \  5.  Surface  water  from  cultivated  ^ 
•  I  land. 

f  6.  River  water  to  which  sewage   j- 
Dangerous.  gains  access. 

1 7.  Shallow-well  water 


6.  River  water  to  which  sewage   }•         Palatable. 


II.  According  to  softness  : — 

1.  Rain  water. 

2.  Upland  surface  water. 

3.  Surface  water  from  cultivated  land 

4.  River  water. 

5.  Spring  water. 

6.  Deep-well  water. 

7.  Shallow- well  water. 

III.  In  respect  of  the  influence  of  geological  forma- 
tion in  rendering  water  sparkling,  colourless,  palatable, 
and    wholesome,    by    percolation,    the    following    water- 
bearing strata  are  given  as  the  most  efficient : — 

1.  Chalk. 

2.  Oolite. 

3.  Greensand. 

4.  Hastings  sand. 

5.  New  red  and  conglomerate  sandstone. 

SECTION  II. — QUANTITY  NECESSARY  FOE  HEALTH  AND 
OTHER  PURPOSES. 

A  healthy  adult  requires  daily  from  70  to  100  oz.  of 
water  for  the  processes  of  nutrition,  about  one -third  of 


WATER.  145 

which  is  contained  in  articles  of  diet,  the  other  two-thirds 
being  supplied  in  the  form  of  liquids.  The  amount  for 
cooking  has  been  estimated  at  from  half  a  gallon  to  a 
gallon  daily  for  each  person,  while  the  quantity  deemed 
necessary  for  personal  cleanliness  and  for  washing  pur- 
poses will  necessarily  vary  very  much  according  to  the 
habits  of  the  individual. 

Dr.  Parkes  has  given  the  following  quantities  used 
by  a  man  in  the  middle  class  : — 

Gallons  daily. 

Cooking -75 

Fluids  as  drink      ......  '33 

Ablution,  including  a  daily  sponge-bath         .  5 

Share  of  utensil  and  house  washing        .         .  3 

Share  of  clothes  washing        ....  3 

12-08 

The  soldier  is  allowed  about  1 5  gallons  daily,  no  extra 
allowance  being  given  for  the  women  and  children  in  a 
regiment.  In  the  poorer  districts  of  the  city  of  London, 
Dr.  Letheby  found  that  the  amount  used  was  5  gallons 
per  individual  daily,  and  in  model  lodging-houses,  accord- 
ing to  Mr.  Muir,  7  gallons.  In  the  cottages  of  the  poor 
in  country  districts  where  water  is  scarce,  the  amount  in 
many  instances  does  not  exceed  3  gallons,  but  then  the 
inhabitants  are  not  cleanly.  A  shower-bath  daily  will 
require  3  to  4  gallons,  while  a  plunge-bath  will  take  from 
40  to  60  gallons.  Where  water-closets  are  used,  an 
additional  allowance  of  from  4  to  6  gallons  must  be  pro- 
vided. Latrines  require  a  less  amount. 

In  gross  amounts  Professor  Rankine  has  given  an 
estimate  of  10  gallons  daily  per  individual  for  domestic 
purposes,  10  for  municipal  purposes,  and  10  more  for 
trade  purposes  in  manufacturing  towns,  and  this  amount, 
large  though  it  seems,  is  actually  supplied  to  many  towns 
at  the  present  day.  Glasgow,  for  example,  receives  50 

L 


146  WATER. 

gallons  daily  per  head  of  population;  Edinburgh  and 
Southampton  35;  Paris  31;  and  Liverpool  30.  The 
different  London  water  companies  supply  from  21  to  34 
gallons — the  mean  average  being  2  8  ;  while  the  manu- 
facturing towns  in  Lancashire  and  Yorkshire,  according 
to  Mr.  Bateman,  received  from  16  to  21  gallons.  In 
Norwich  the  average  supply  is  only  12  gallons,  and  in 
Derby  14.  Mr.  Eawlinson's  minimum  estimate  for 
manufacturing  towns  is  20  gallons  per  head  daily,  and  if 
care  be  taken  to  prevent  needless  waste  this  amount  will 
be  quite  sufficient.  There  is  no  doubt  that  a  large  pro- 
portion of  the  waste  is  connected  with  water-closets,  ajid 
especially  those  which  are  directly  flushed  from  the  mains, 
and,  as  an  instance  in  point,  I  may  mention  that  when 
all  such  direct  communication  was  cut  off  in  the  town  of 
Warwick  on  my  recommendation,  the  supply  was  reduced 
from  33  to  20  gallons  per  head  daily. 

In  apportioning  the  daily  allowance  for  all  purposes, 
Dr.  Parkes  has  given  the  following  estimate : — 

Gallons  per  head 
of  population. 

Domestic  supply       .         .         .         .         .        .  12 

General  baths 4 

Water-closets   .......  6 

Unavoidable  waste    ......  3 

Total  house  supply  ......  25 

Municipal  purposes  ......  5 

Trade  purposes  5 

Total          35 

No  doubt  this  estimate  may  be  regarded  as  somewhat 
excessive,  especially  in  the  items  of  domestic  and  water- 
closet  supply,  but  it  has  been  based  on  the  principle  that 
a  liberal  allowance  is  not  only  necessary  for  thorough 
cleanliness,  but  that  it  is  also  required  for  an  efficient 
clearage  of  sewers.  There  can  be  no  question,  however, 


WATER.  147 

that  the  amount  of  water  habitually  wasted  in  many 
towns  is  enormous,  reaching  in  all  probability  to  at  least 
one  third  of  the  supply,  and  this,  when  the  water  has  to 
be  pumped  into  the  town,  or  when  the  town  sewage  has 
to  be  pumped  or  chemically  treated  in  any  way  at  the 
outfall,  increases  the  rates  to  a  very  considerable  extent. 
While  part  of  this  waste  is  due  to  underground  leakage 
from  pipes  and  mains,  by  far  the  larger  portion  of  it  is 
due  to  imperfect  household  fittings,  and  to  carelessness  in 
leaving  stool-cocks  and  bib-cocks  open  in  connection  with 
water-closets  whose  flush  pipes  communicate  directly  with 
the  mains.  All  closets  should  be  provided  with  cisterns 
of  the  waste-preventing  class,  but  of  sufficient  capacity  to 
flush  the  closet-pan  when  used. 

For  hospitals  the  daily  amount  per  patient  may  be 
estimated  at  about  30  gallons.  In  prisons  and  work- 
houses the  quantity  will  vary  according  to  the  bathing 
arrangements,  and  whether  water-closets  are  used.  In 
the  Convict  Prison,  Portsmouth,  where  water-closets  and 
water-latrines  are  both  in  use,  and  where  each  prisoner  is 
allowed  a  general  bath  once  a  week,  I  found  that  the 
amount  averaged  about  11  gallons  per  convict  daily. 

SECTION  III. — MODES  OF  SUPPLY. 

This  part  of  the  subject  has  reference  to  wells,  borings, 
the  collection  and  storage  of  water,  and  to  waterworks 
generally. 

1.  Wells  and  Borings. — In  small  urban  and  rural 
districts  surface  wells,  whether  as  ordinary  pump  wells, 
draw  wells,  or  shallow  dip  wells,  constitute  the  usual 
source  of  supply,  and  though  they  may  naturally  yield  a 
wholesome  water,  the  surrounding  soil  often  becomes  so 
saturated  with  impurities  that  it  is  next  to  impossible  to 
prevent  their  pollution.  In  crowded  localities,  therefore, 


148  WATER. 

they  should  always  be  regarded  with  suspicion,  and,  as  far 
as  possible,  their  use  should  be  discontinued.  Deep  wells, 
on  the  other  hand,  are  not  open  to  this  objection,  because 
they  are  generally  sunk  through  an  impervious  stratum, 
which  prevents  the  infiltration  of  any  surface  impurities, 
and  at  the  same  time  serves  to  keep  down  the  water  in 
the  porous  strata  beneath.  The  quality  of  the  water  from 
these  wells,  as  has  already  been  shown,  will  depend  on 
the  nature  of  the  geological  formation  of  the  district.  It 
is  also  apparent  that,  in  accordance  with  a  well-known 
physical  law,  it  is  only  necessary  to  bore  through  the 
impervious  stratum,  and  reach  the  water-bearing  bed,  for 
the  water  to  rise  to  the  surface,  or  to  within  a  short  dis- 
tance of  it,  so  as  to  be  collected  in  a  well  of  ordinary 
dimensions.  Indeed,  in  certain  low-lying  districts,  where 
a  boring  is  made  at  a  point  considerably  below  the  level 
of  the  line  of  infiltration  into  the  water-bearing  stratum, 
the  water  rises  above  the  surface  and  overflows.  Such 
overflowing  wells,  or  artesian  wells  as  they  are  called, 
were  once  common  in  the  valley  of  the  Thames,  and  are 
still  to  be  met  with  in  the  flat  lands  of  Essex  and  on  the 
coast  of  Lincolnshire.  Ordinary  borings  differ  from  artesian 
wells  in  not  piercing  through  a  retentive  stratum  in  order 
to  reach  the  water-supply.  They  are  very  common  in  the 
chalk  and  new  red  sandstone  districts,  and  are  made  to 
increase  the  yield  of  the  wells.  Practically,  it  is  found 
that  one  boring  adds  to  the  supply  of  a  well  nearly  as 
much  as  several.  Thus  in  the  Bootle  well  at  Liverpool, 
with  16  bore -holes,  some  of  which  were  600  feet  deep, 
Mr.  Stephenson  found  that  when  all  were  plugged  up 
but  one,  the  yield  was  921,192  gallons  per  day,  and 
when  all  were  open  it  was  only  increased  by  112,792 
gallons. 

Deep  wells  are  now  being  abandoned  for  the  supply 
of  large  towns,  because  they  are  found  to  be  insufficient 


WATER.  149 

for  the  wants  of  a  rapidly  -  increasing  population,  and 
obviously  cannot  be  multiplied  within  a  given  district 
beyond  certain  limits,  because  every  single  well  drains  a 
surrounding  area  of  some  considerable  extent.  For  large 
isolated  buildings,  however,  such  as  lunatic  asylums, 
workhouses,  and  prisons,  they  usually  supply  the  whole 
of  the  water  required ;  and  in  selecting  a  site  in  the 
country  for  any  such  building,  the  possibility  of  obtaining 
the  requisite  water-supply,  and  the  cost  at  which  it  can 
be  procured,  are  points  of  the  first  importance. 

Generally  speaking,  the  chance  of  obtaining  a  good 
supply  will  depend  upon  the  nature  of  the  underlying 
strata,  and  upon  the  level  of  the  proposed  site.  Wells 
sunk  in  superficial  sand  or  gravel  beds,  though  yielding  a 
good  supply  at  ordinary  times,  are  very  liable  to  have 
their  yield  very  much  lessened  in  seasons  of  drought, 
unless  they  are  situated  at  points  considerably  below  the 
level  of  the  surrounding  country,  and  the  same  remark 
applies  to  surface  wells  in  the  chalk  districts.  On  the 
other  hand,  deep  wells  or  borings  in  the  new  red  sand- 
stone, and  oolite  or  chalk  formations,  usually  yield  a  large 
and  constant  supply,  because  these  permeable  rocks  are 
so  saturated  with  water  that  they  may  be  regarded  as 
vast  subterranean  reservoirs.  The  deepest  artesian  wells 
in  the  world  are  those  at  Grenelle  in  Paris  and  Kissengen 
in  Bavaria,  the  former  being  1800  and  the  latter  1878 
feet  in  depth. 

The  Commissioners,  in  the  report  already  alluded  to, 
strongly  urge  "  that  preference  should  always  be  given  to 
spring  and  deep-well  water  for  purely  domestic  purposes, 
over  even  upland  surface  water,  not  only  on  account  of 
the  much  greater  intrinsic  chemical  purity  and  palatability 
of  these  waters,  but  also  because  their  physical  qualities 
render  them  peculiarly  valuable  for  domestic  supply. 
They  are  almost  invariably  clear,  colourless,  transparent, 


150  WATER. 

and  brilliant,  qualities  which  add  greatly  to  their  accept- 
ability as  beverages ;  whilst  their  uniformity  of  tempera- 
ture throughout  the  year  renders  them  cool  and  refreshing 
in  summer,  and  prevents  them  from  freezing  readily  in 
winter.  Such  waters  are  of  inestimable  value  to  com- 
munities, and  their  conservation  and  utilisation  are  worthy 
of  the  greatest  efforts  of  those  who  have  the  public  health 
under  their  charge." 

The  following  are  some  of  the  towns  which  are  sup- 
plied by  deep  wells  : — Canterbury,  Cambridge,  Bury  St. 
Edmunds,  and  Deal,  from  the  chalk  formation ;  Birken- 
head,  Coventry,  Leamington,  and  Southport,  from  the  new 
red  sandstone;  and  Bedford  and  Scarborough  from  the 
oolite. 

For  a  small  or  temporary  supply  the  American  tube 
well  (Norton's  patent)  has  been  found  to  be  very  useful. 
It  consists  of  a  narrow  iron  tube  driven  into  the  ground 
in  lengths,  the  lower  part  being  pointed  and  perforated  at 
its  end,  and  is  fitted  with  a  single  or  double  action  pump 
according  to  the  depth.  The  water  enters  the  tube 
through  the  perforations,  and,  if  the  bed  is  sandy,  has  to 
be  filtered  for  some  time,  until,  by  gradual  removal  of 
the  sand,  a  well  is  formed  around  the  lower  end,  and  the 
water  is  obtained  without  sediment.  This  pump  is 
especially  adapted  for  country  districts,  and  it  possesses 
the  further  advantage  of  helping  to  keep  out  surface 
impurities. 

In  order  to  ascertain  the  yield  of  surface  wells,  the 
water  must  be  pumped  out,  and  the  time  noted  which  is 
required  for  refilling.  The  yield  of  small  springs  can  be 
readily  measured  by  receiving  the  water  into  a  vessel  of 
known  dimensions,  such  as  a  cask,  and  also  noting  the 
time  which  it  takes  to  fill. 

2.  Waterworks. — In  addition  to  deep  wells,  water- 
works on  an  extensive  scale  obtain  their  supply  from 


WATER.  151 

lakes,  streams,  rivers,  or  gathering -grounds.  If  from  a 
lake  of  sufficient  elevation  above  the  level  of  the  town  to 
be  supplied,  the  water  may  be  distributed  throughout  the 
town  in  conduits  and  pipes  by  the  force  of  gravity. 
When  the  source  of  supply  is  a  stream  or  small  river, 
storage  works  are  necessary ;  but  when  the  river  is  large, 
a  constant  supply  can  be  obtained  at  all  times,  independ- 
ently of  storage.  In  this  case,  the  works  required  usually 
comprise — a  weir  or.  dam  for  maintaining  part  of  the 
river  at  a  nearly  constant  level ;  two  or  more  settling- 
ponds,  into  which  the  water  is  conducted ;  filtering  appa- 
ratus, and  pumping  engines. 

When  it  is  required  to  ascertain  the  yield  of  any 
small  stream,  it  is  usual  to  employ  a  weir-gauge  to  dam 
up  the  water  into  a  pond  behind,  and  allow  it  to  flow 
through  a  sluice  or  over  a  sill  of  known  dimensions.  In 
the  case  of  an  average-sized  stream,  a  rough  approxima- 
tion of  the  yield  may  be  obtained  by  taking  the  breadth 
and  depth  at  several  distances  in  a  short  section  of  the 
channel  which  is  tolerably  uniform,  and  thus  ascertaining 
the  average  sectional  area.  The  surface  velocity  may  then 
be  taken  by  noting  the  time  occupied  in  floating  a  light 
object  over  the  selected  distance,  and  as  four-fifths  of  the 
surface -velocity  are  about  equal  to  the  actual  velocity, 
the  yield  in  cubic  feet  or  gallons  per  second  can  be  easily 
calculated. 

When  the  water-supply  of  a  town  is  collected  from 
small  streams  or  gathering -grounds,  the  rainfall  of  the 
catchment  basin  and  its  available  amount  are  items  which 
ought  to  be  carefully  inquired  into.  The  ratio  of  the 
available  to  the  total  rainfall,  as  already  shown,  is 
influenced  by  the  nature  of  the  soil,  the  steepness  or  flat- 
ness of  the  ground,  the  rapidity  of  the  rainfall,  and  other 
circumstances.  Professor  Rankine  has  given  the  follow- 
ing examples  : — • 


152  WATER. 

Available  Rainfall 
GROUND-  divided  by  Total  Rainfall. 

Steep  surfaces  of  granite,  gneiss,  and  slate,  nearly  1 

Moorland  hilly  pastures       .          .          from  '8  to  "6 

Flat  cultivated  country       .          .          from  '5  to  -4 
Chalk      .                    ...                    0 

The  average  annual  rainfall  in  different  parts  of  this 
country  varies  from  '22  to  140  inches,  the  least  recorded 
depth  being  15  inches.  It  is  greater  in  mountainous 
than  in  flat  districts,  and  on  the  leeward  side  of  a  moun- 
tain ridge  than  it  is  on  the  side  facing  the  prevailing 
winds.  As  regards  water-supply,  the  most  important 
data  are  the  least  annual  rainfall  and  the  longest  period 
of  drought. 

In  selecting  drainage  areas,  it  must  be  borne  in  mind 
that  the  nearer  the  actual  rainfall  water  is  collected  the 
freer  it  will  be  from  impurities,  and  that  purity  of  water 
and  fertility  of  soil  are  not  to  be  expected  together. 
Water  collected  from  a  peaty  soil  will  contain  large  quan- 
tities of  vegetable  matter,  while  that  from  a  soil  well 
cultivated  will  be  tainted  with  animal  impurities.  The 
purest  water,  therefore,  which  can  be  collected  from 
drainage  areas  is  found  in  the  barren  moorland  districts 
of  the  primary  geological  formations,  or  of  the  sandstone 
rocks. 

The  channels  of  the  gathering-ground  may  either  be 
the  natural  watercourses  of  the  district,  or  these  may  be 
supplemented  by  adits,  closed  drains,  or  open  ditches. 
The  latter,  however,  are  objectionable  because  they  form 
receptacles  for  vegetable  matter,  and  as  the  current  in 
them  must  be  necessarily  slow,  there  is  considerable  loss 
by  evaporation.  The  position,  extent,  and  dimensions  of 
the  adits  leading  to  the  reservoir  will  depend  upon  the 
configuration  of  the  district.  The  reservoir  itself  is  gener- 
ally a  natural  hollow,  situated  in  the  valley-line  of  the 


WATER.  153 

catchment  basin,  and  of  sufficient  elevation  to  procure  a 
fall,  so  that  the  water  can  be  distributed  without 
mechanical  means  being  required  to  raise  it.  In  this 
country  the  storage-room  should  be  large  enough  to  con- 
tain a  four  or  six  months'  supply ;  and  the  site  which 
can  supply  the  requisite  storage -room  with  the  least 
embankment,  the  least  amount  of  puddle,  and  the  least 
area  laid  under  water,  is  to  be  preferred. 

Upon  the  strength  and  stability  of  the  embankment 
everything  depends.  It  is  made  watertight  by  a  core  of 
clay  puddle,  the  inner  slope  being  protected  from  the 
action  of  the  water  by  a  pitching  of  dressed  stones,  and 
the  outer  from  the  effects  of  the  weather  by  a  covering 
of  grass  sods.  The  puddle-core  generally  amounts  to  a 
tenth  of  the  whole  embankment.  The  height  of  the 
embankment  varies  from  3  to  10  feet  above  the  highest 
water-level,  the  top  being  covered  with  broken  stones. 
No  trees  or  shrubs  are  allowed  to  grow  upon  it,  and  the 
greatest  care  is  taken  in  its  construction  to  prevent 
animals,  such  as  water-rats,  bun-owing  into  it. 

Every  impounding  reservoir,  as  it  is  called,  is  pro- 
vided with  an  overflow  weir  to  permit  the  discharge  of 
the  flood  supply  from  the  drainage  area,  and  this  is  often 
supplemented  by  a  channel  termed  the  lye-wash,  which  is 
used  to  divert  the  streams  supplying  the  reservoir,  so  as 
to  prevent  fouling  of  the  store-water.  The  flood-water 
carried  off  in  this  way  flows  into  the  natural  water- 
course. 

In  order  to  remove  the  sediment  which  collects  in 
the  bottom  of  the  reservoir,  there  is  always  a  cleansing 
pipe  as  well  as  a  discharge  pipe,  the  former  being  on  a 
level  with  the  lowest  point  in  the  reservoir,  and  discharg- 
ing into  the  natural  watercourse  below  the  embankment. 
Both  are  carried  through  a  culvert  in  the  embankment, 
which  is  built  of  stone  or  brick,  and  founded  on  the 


154  WATER. 

solid  rock.  The  aqueduct  or  discharge -pipe  bends  up- 
wards in  the  reservoir,  and  has  a  series  of  inlets,  the 
lowest  at  the  lowest  working  level,  and  the  whole  of  them 
guarded  against  the  entrance  of  small  stones,  pieces  of 
wood,  or  other  bodies,  which  would  interfere  with  the 
action  of  the  valves.  The  sluices  which  are  required 
for  both  pipes  are  situated  in  the  reservoir,  and  are 
worked  from  the  sluice-tower. 

The  aqueduct  is  that  portion  of  the  conduit  leading 
from  the  reservoir  to  the  distributing  conduits.  It  may 
be  open  or  close  throughout,  or  partly  close  and  partly 
open.  If  close,  it  generally  consists  of  a  train  of  cast- 
iron  pipes  securely  jointed,  bedded  on  a  firm  foundation, 
and  covered  to  a  depth  of  at  least  2  or  3  feet,  to  preserve 
them  from  frost.  Sluice  stop-cocks  are  provided  in  the 
valleys,  for  the  purpose  of  scouring  out  any  stones  or 
sediment,  and,  at  intervals  not  exceeding  half  a  mile,  to 
permit  of  repairs.  Valve-cocks  are  supplied  at  all  the 
principal  summits,  to  allow  the  escape  of  air.  When  the 
aqueduct  is  partly  close  and  partly  open,  or  if,  when 
close,  it  cannot  withstand  the  whole  pressure  when  the 
demand  ceases,  either  a  system  of  weirs  is  required  to 
discharge  the  surplus  water,  or  a  second  store-reservoir  is 
provided,  resembling  in  general  plan  and  construction 
the  impounding  reservoir. 

The  distributing  conduits  also  consist  of  cast-iron 
pipes,  and  are  coated,  like  the  aqueduct  pipes,  with  pitch, 
or  Dr.  Angus  Smith's  varnish,  to  preserve  them  from  cor- 
rosion. The  same  details  with  regard  to  sluice-cocks  and 
stop-cocks  are  observed  in  the  different  bends  of  the 
tracks,  with  this  addition,  that  the  dead  ends  or  termina- 
tions of  the  branch  and  main  conduits  are  supplied  with 
scouring  valves,  through  which  stones  and  sediment  can 
be  washed.  In  wide  streets,  or  in  streets  with  much 
traffic,  there  is  generally  a  service  pipe  for  each  side,  in 


WATER.  155 

order  that  the  house-pipes  may  be  as  short  as  possible, 
and  may  be  accessible  without  disturbing  the  traffic.  The 
house  service-pipes  are  usually  made  of  lead,  and  though 
they  are  liable  to  be  acted  upon  by  some  waters,  the 
readiness  with  which  they  can  be  adapted  to  all  the  bends 
and  curves  rendered  necessary  in  carrying  the  piping  to 
different  floors  of  houses,  gives  them  a  preference  to  all 
other  kinds  of  metal  pipes.  The  waters  which  act  most 
on  lead  are  the  most  highly  oxygenated,  and  those  which 
contain  organic  matter ;  those  which  act  least  on  it  con- 
tain carbonic  acid,  calcium  carbonate,  and  calcium  phos- 
phate. Polluted  shallow -well  waters  are  especially 
dangerous  in  this  respect,  because  they  act  on  it  violently 
and  continuously,  and  hence  leaden  pump -pipes  should 
never  be  used.  Various  means  have  been  proposed  to 
protect  the  lead  from  corrosion,  such  as  coating  with  bitu- 
minous pitch  or  with  coal  tar;  but  when  the  quality 
of  the  water  renders  lead  pipes  objectionable,  cast  and 
wrought  iron  pipes  make  the  best  substitutes,  or  com- 
posite cylinder  pipes.  These  pipes  consist  of  a  separate 
tube  of  pure  block-tin  encased  in  lead,  and  the  union  of 
the  two  is  so  perfect  that  no  amount  of  torsion  will 
separate  them. 

As  the  greatest  hourly  demand  for  water  is  about 
double  the  average  hourly  demand,  the  main  conduits 
supplying  a  town  must  have  double  the  discharging  capa- 
city which  would  be  required  if  the  hourly  demand  were 
uniform.  The  additional  expense  in  piping  which  would 
be  thus  entailed  is  sometimes  so  great  that  distributing 
basins  or  town-reservoirs  are  constructed  to  supply  certain 
districts.  To  meet  all  emergencies,  tljey  are  made  large 
enough  to  contain  at  least  a  day's  supply,  and  they  must 
also  have  a  site  of  sufficient  elevation  to  ensure  distribu- 
tion by  hydrostatic  pressure.  Every  such  reservoir  should 
be  roofed  in  and  ventilated,  to  protect  the  water  from 


156  WATER. 

frost  and  heat,  and  from  becoming  tainted  with   aerial 
impurities. 

The  water  thus  distributed  to  the  various  houses  in 
a  district  is  supplied  either  on  the  intermittent  or  con- 
stant system.  The  intermittent  system  necessitates 
storage  in  house  cisterns,  and  is  attended  by  so  many 
disadvantages,  that  the  constant  system  should  always  be 
adopted  wherever  it  can  be  carried  out.  The  use  of 
cisterns,  except  on  a  small  scale,  for  water-closets  and 
boilers,  is  open  to  the  great  objection  of  the  risk  of  con- 
tamination of  the  water,  for  not  only  are  the  cisterns 
liable  to  become  fouled  if  not  sufficiently  protected  against 
the  entrance  of  aerial  impurities,  but  the  water  is  apt  to 
become  tainted  with  sewer-gases.  Moreover,  in  poorer 
districts,  the  cisterns  are  often  of  a  very  inferior  descrip- 
tion, are  badly  situated,  and  are  seldom  inspected  or 
cleaned  out.  To  meet  this  objection,  it  has  been  pro- 
posed to  have  one  large  tank  for  the  supply  of  a  group 
of  houses, — the  tank  to  be  under  the  immediate  inspec- 
tion of  the  waterwork  officials,  and  to  be  filled  daily,  and 
the  householders  to  be  supplied  through  small  pipes  con- 
stantly charged.  It  is  further  urged  against  the  inter- 
mittent system,  that  the  distribution  pipes,  being  alter- 
nately wet  and  dry,  are  liable  to  collect  dust  and  the 
effluvia  from  sewers  or  drains.  The  objections  to  the 
constant  system,  on  the  other  hand,  are  the  great  waste 
when  the  fittings  are  imperfect,  and  an  insufficient  de- 
livery when  the  water-supply  is  not  abundant.  _  The 
diameters  of  the  pipes  for  constant  service  should  there- 
fore be  carefully  adapted  to  their  discharges  and  to  the 
head  of  pressure ;  the  drawing  taps  ought  to  be  valve- 
cocks  to  open  and  shut  with  a  screw ;  and  the  town 
should  be  efficiently  provided  with  distributing  basins,  so 
that  an  extra  flow  of  water  in  one  district  would  not  in- 
terfere with  the  requisite  supply  of  other  parts.  With 


WATER.  157 

proper  fittings,  strict  regulations,  and  efficient  supervision, 
it  is  now  clearly  established  that  a  constant  supply  re- 
quires a  less  amount  of  water  than  an  uncontrolled  inter- 
mittent supply,  so  that  even  on  the  score  of  economy  the 
constant  system  is  to  be  preferred. 

In  order  to  prevent  undue  waste,  water-meters  are 
sometimes  applied  to  the  service-pipe  supplying  a  group 
of  houses,  and  the  landlord  charged  for  the  amount  used ; 
but  as  this  plan  induces  the  landlord  to  enforce  a  too 
rigid  economy,  it  is  not  to  be  commended.  The  best 
water-meters  are  capable  of  registering  exactly  all  amounts 
exceeding  a  flow  of  one  gallon  per  hour ;  but  when  the 
water  contains  a  considerable  amount  of  undissolved  im- 
purities, and  is  badly  filtered,  they  very  soon  become 
clogged  up  and  fail  to  register  anything  like  the  quantity 
of  water  which  may  pass  through  them. 
*•  ,  The  waste-preventer,  or  small  cistern  for  the  supply 
of  water-closets,  which  has  already  been  alluded  to,  should 
at  least  hold  2  gallons.  The  smallest  waste-preventers 
hold  %  of  a  gallon,  but  this  quantity  is  insufficient  to 
flush  the  pan  and  soil-pipe  properly. 

Another  plan  for  effecting  economy  in  the  constant 
system,  proposes  that  a  cistern,  large  enough  to  hold  a 
twenty-four  hours'  supply,  be  provided  for  each  house,  and 
that  the  service-pipe  shall  be  of  a  diameter  to  deliver  the 
required  quantity  during  that  time,  and  nothing  more. 
Every  cistern  supplied  in  this  way  would  become  gradu- 
ally emptied  during  the  day  time,  and  would  be  refilled 
during  the  night ;  but  the  plan  is  open  to  the  great  ob- 
jection attaching  to  the  intermittent  system,  and  does  not 
sufficiently  provide  for  emergencies. 

Wherever  cisterns  are  employed,  they  should  be  so 
situated  that  they  can  be  readiJy  cleaned  out  when  neces- 
sary. The  best  materials  for  their  construction  are  slate- 
slabs  well  set  in  cement,  or  galvanised  iron.  Leaden 


158  WATER. 

cisterns,  unless  lined  with  a  coating  of  pitch,  tar,  or  other 
preservative  substances,  are  objectionable.  All  cisterns 
should  be  covered  in,  and  protected  from  heat  and  frost. 
No  cistern  which  supplies  water  for  domestic  use  should 
be  used  to  directly  supply  a  water-closet ;  a  waste-pre- 
venting cistern  should  always  intervene.  The  inlet  to 
every  cistern  ought  to  have  a  cock,  with  a  float  to  rise 
and  stop  the  supply  when  the  cistern  is  full ;  and  when 
the  supply  is  constant,  the  overflow  should  be  so  arranged 
as  to  become  troublesome  if  not  immediately  rectified. 
An  overflow  pipe  from  a  cistern  should  never  lead  directly 
into  a  soil-pipe,  sewer,  or  drain,  but  should  end  above 
ground  over  a  trapped  and  ventilated  grating.  If  this 
were  always  attended  to,  no  sewer-gases  could  find  their 
way  to  the  cistern  through  this  channel. 

In  addition  to  the  arrangements  for  domestic  supply, 
outlets  or  hydrants  with  valve-cocks  are  provided  on  the 
service-pipes  of  all  large  towns,  at  regular  intervals,  in 
case  of  fire,  and  for  supplying  water  to  flush  the  gutters 
and  water  the  streets. 

In  laying  down  water-pipes  and  mains,  it  is  of  great 
importance  that  the  separation  between  them  and  sewers, 
drains,  or  gas  pipes  should  be  as  wide  as  possible.  Whether 
the  water-supply  be  on  the  constant  or  intermittent  sys- 
tem, the  risk  of  suction  of  gases  or  fluids  into  leaky  mains 
is  imminent,  though  of  course  much  less  when  the  supply 
is  constant.  Unfortunately,  however,  this  danger  of  con- 
taminating public  water-supplies  has  hitherto  not  been 
appreciated,  and  indeed  in  many  towns,  as  for  example  in 
Croydon,  it  has  been  enhanced  by  arrangements  for  flush- 
ing sewers  directly  from  the  mains. — (See  Mr.  Simon's 
Reports,  New  Series,  No.  VII.) 

Another  danger  to  a  public  water-supply  is  the  direct 
connection  of  water-drains  with  closet-pans.  In  Warwick 
and  Eugby  I  found  that  nearly  one-fourth  of  the  closets 


WATER.  159 

were  flushed  directly  from  the  main  by  means  of  stool- 
cocks,  and  on  my  recommendation  the  whole  of  them 
were  disconnected. 


SECTION  IV. — PURIFICATION  OF  WATER. 

On  an  extensive  scale  the  process  of  purification  is 
carried  on  by  means  of  filtration,  the  water  being  received 
into  large  filter-beds  previous  to  its  distribution.  A  filter- 
bed  may  be  described  as  a  tank  or  reservoir  several  feet 
in  depth,  with  paved  bottom,  on  which  are  laid  a  series 
of  open-jointed  or  perforated  tubular  drains  leading  into 
a  central  culvert.  The  drains  are  covered  with  a  layer 
of  gravel  about  3  feet  deep,  over  which  is  spread  a  layer 
of  sand  about  2  feet  deep.  The  layer  of  gravel  is  coarse 
at  the  bottom,  becoming  gradually  finer  towards  its  upper 
surface,  and  the  same  relative  gradation,  as  regards  coarse- 
ness and  fineness,  is  observed  with  regard  to  the  sand. 
The  water  is  delivered  uniformly  and  slowly,  and  in  order 
that  the  filtering  process  may  not  be  carried  on  hurriedly, 
the  pressure  is  always  kept  low,  the  depth  of  water  being 
seldom  above  2  feet,  and  in  some  cases  only  1  foot.  The 
speed  of  vertical  descent  should  not  be  much  above  6 
inches  per  hour,  nor  should  the  rate  of  filtration  much 
exceed  700  gallons  per  square  yard  of  filter-bed  in  the 
24  hours,  although  some  water  companies  filter  at  a  much 
more  rapid  rate  than  this.  In  large  works  there  are 
always  several  filter-beds,  to  allow  of  some  being  cleansed 
while  the  others  are  in  use.  The  sediment  deposited  on 
the  surface  of  the  sand  requires  to  be  scraped  off  at 
intervals,  and  at  each  cleansing  operation  about  half  an 
inch  of  sand  is  also  removed.  A  fresh  supply  of  sand  is 
added  when  the  depth  of  the  layer  is  reduced  to  an  extent 
which  threatens  to  impair  the  efficiency  of  the  filter.  It 
appears  that  proper  filtration,  carried  on  according  to  this 


160  WATEE. 

plan,  removes  suspended  impurities,  and  a  certain  amount 
of  dissolved  mineral  substances,  but  whether  dissolved 
organic  matters  are  destroyed,  or  oxidised  to  any  consider- 
able extent,  seems  doubtful. 

Small  filters  for  domestic  use  may  be  placed  in  the 
cistern,  in  the  course  of  the  delivery  pipe,  or  they  may  be 
filled  by  hand.  As  filtering  media  various  substances  are 
used,  such  as  animal  or  vegetable  charcoal,  a  mixture  of 
fine  silica  and  charcoal,  magnetic  carbide  of  iron,  sponges, 
wool,  etc.  According  to  Dr.  Parkes,  the  best  filters  are 
made  either  of  animal  charcoal  or  magnetic  carbide  of 
iron.  They  are  capable  of  removing  almost  all  the 
suspended  matters,  and  at  least  40  per  cent  of  dissolved 
organic  impurities,  together  with  a  considerable  amount 
of  salts,  such  as  calcium  carbonate  and  sodium  chloride. 
Indeed,  the  experiments  of  Mr.  Wanklyn  with  the  siiicated 
carbon-filter  prove  that,  by  repeated  filtration,  river  water 
containing  a  considerable  amount  of  free  and  albuminoid 
ammonia  may  be  made  as  pure  as  deep  spring  water. 

Of  filtering  media,  animal  charcoal,  properly  washed, 
is  now  admitted  to  be  in  every  way  the  most  efficient, 
but  it  should  be  frequently  renewed.  It  exerts  a  chemical 
as  well  as  mechanical  action  on  organic  impurities,  and 
Dr.  Frankland  is  so  convinced  of  its  value  as  a  filtering 
agent  that  he  recommends  its  employment  on  a  large 
scale  for  the  purification  of  town  supplies,  in  spite  of  the 
cost  which  would  be  entailed.  Professor  Bischof  has  also 
discovered  that  spongy  iron  possesses  remarkable  purify- 
ing properties,  which  have  been  fully  confirmed  by  the 
experiments  of  the  Eivers  Pollution  Commissioners,  and 
it  may  here  be  stated  that  the  spongy  iron  filter  received 
the  medal  of  the  Sanitary  Institute  a  few  years  ago  for 
its  general  excellence.  Carferal  is  another  substance 
which  has  lately  been  introduced,  and  is  highly  spoken 
of  as  a  filtering  medium.  It  resembles  charcoal  in  ap- 


WATER.  161 

pearance,  and  consists  of  a  mixture  of  charcoal,  iron,  and 
clay. 

Amongst  other  filters  which  have  been  commended 
for  their  efficiency,  may  be  mentioned  the  cistern  filter 
of  the  Water  Purifying  Company,  London ;  Lipscombe's 
Self-Cleaning  Charcoal  Filter;  the  Patent  Carbon  Block 
Filter,  manufactured  by  Atkins  and  Co.,  London ;  the 
Carbon  Cistern  Filter,  planned  by  Mr.  Finch  of  the  Hoi- 
born  Sanitary  Works ;  and  the  various  filters  devised  by 
Halliday  and  ^Co.  of  Manchester,  and  Doulton  and  Co.  of 
London.  All  of  these  contain  animal  charcoal  as  the  filter- 
ing medium,  and  can  be  applied  to  any  kind  of  house 
cistern.  The  filtering  block  of  the  Silicated  Carbon 
Company  consists  of  75  per  cent  of  charcoal  and  22  of 
silica,  with  a  little  iron  oxide  and  alumina.  It  is  cemented 
into  a  vessel  which  it  divides  into  two  chambers,  the  one 
containing  the  filtered  and  the  other  the  unfiltered  water. 
This  filter  is  found  to  work  very  efficiently,  and  with  a 
little  care  retains  its  properties  for  a  long  time.  The 
filtering  material  of  the  Magnetic  Carbide  Filter  is  pre- 
pared by  heating  haematite  with  sawdust,  and  has  all  along 
been  highly  commended.  The  Patent  Moulded  Carbon 
Filter  makes  an  elegant  article  for  the  sideboard.  It 
consists  of  two  glass  vessels,  the  upper  containing  the 
filter-block,  and  the  lower,  which  can  be  used  as  a  water 
bottle,  the  filtered  water.  Tap-filters,  suited  for  a  high  or 
low  pressure,  can  be  fitted  to  the  pipes  themselves.  They 
contain  charcoal  or  silicated  carbon,  and  would  seem  to 
act  very  well.  Mr.  Bailey  Den  ton's  "  Self- Supply  ing 
Aerated  Filter  "  is  placed  beneath  the  house  cistern,  and 
by  a  simple  arrangement  of  valve-cocks  as  much  water  is 
supplied  to  the  cistern  as  is  removed  from  the  filter  every 
time  water  is  drawn  off.  Amongst  other  domestic  filters 
may  be  mentioned  Dr.  Bond's  Patent  Floating  Feed 
Filter  and  Floating  Syphon  Filter,  Dr.  Bernay's  Man- 

II 


162  WATER. 

ganous  Carbon  Filter,  and  M.  Maignen's  "  Filtre.  Rapide," 
in  which  asbestos  cloth  and  a  substance  called  carbo- 
calcis  are  employed  as  the  filtering  media. 

A  charcoal  filter  has  been  introduced  by  Lieut.-Col. 
Crease,  of  the  Royal  Marine  Artillery,  which,  for  sim- 
plicity of  construction,  adaptability  to  different  kinds  of 
water  and  rates  of  supply,  and  for  efficiency,  deserves 
special  notice.  It  is  now  largely  used  in  the  Navy,  and 
is  specially  suited  for  large  buildings,  such  as  asylums, 
workhouses,  etc.  The  tank  is  made  of  iron,  lined  with 
cement,  and  the  whole  of  the  apparatus  can  be  readily 
unscrewed,  taken  to  pieces,  and  cleaned  out  when  neces- 
sary, the  joints  being  made  water-tight  by  gutta-percha 
bands.  Pocket  Syphon  Filters  are  made  of  hollow  blocks 
of  charcoal,  with  a  tube  passing  into  the  cavity,  into  which 
the  water  filters  through  the  charcoal. 

All  filters  after  a  time  become  clogged  up,  and  have 
therefore  to  be  taken  to  pieces  and  thoroughly  cleansed ; 
or,  if  this  cannot  be  easily  done,  they  may  be  purified  by 
passing  through  them  a  solution  of  potassium  perman- 
ganate or  Condy's  fluid,  with  the  addition  of  a  few  drops 
of  strong  sulphuric  acid,  and  afterwards  two  or  three 
gallons  of  pure  or  distilled  water,  acidulated  with  hydro- 
chloric acid.  The  charcoal  in  a  filter  may  also  be  purified 
by  exposing  it  for  some  time  to  the  sun  and  air,  or  by 
heating  it  in  an  oven  or  furnace.  In  the  spongy  •  iron 
filter  the  filtering  medium  has  to  be  renewed  from  time 
to  time. 

The  purification  of  water  without  filtration  is  not 
carried  on  in  this  country  on  the  large  scale  except  by 
Dr.  Clark's  process.  This  consists  in  adding  a  certain 
amount  of  lime  water  to  a  water  which  contains  calcium 
carbonate  rendered  soluble  by  the  presence  of  carbonic 
acid.  Spring  waters  in  the  chalk  districts  are  all  more 
or  less  "  hard,"  and  many  of  them  contain  such  a  large 


WATER.  163 

amount  of  calcium  carbonate  in  solution  as  to  be  unfit 
for  washing  purposes.  Such  a  water,  when  it  is  to  be 
rendered  "  soft "  by  Clark's  process,  is  let  into  a  tank  or 
reservoir,  where  it  is  mixed  with  a  proper  proportion 
of  lime  water  and  allowed  to  settle,  the  whole  of  the 
calcium  being  precipitated  as  calcium  carbonate.  A 
perfectly  clear  and  wholesome  water  is  thus  obtained, 
well  suited  for  domestic  purposes.  Calcium  carbo- 
nate may  also  be  removed  by  boiling,  in  which  case  it 
is  deposited  as  an  incrustation  on  the  inner  surface 
of  the  kettle  or  boiler.  What  is  known  as  the  "  Porter- 
Clark  Process"  is  a  modification  of  Clark's  process, 
which,  at  the  same  time,  provides  for  very  efficient 
filtration. 

Aluminous  salts  have  long  been  used  in  Eastern 
countries  to  purify  water,  and  are  found  to  be  very  effica- 
cious in  removing  suspended  matters,  whether  organic  or 
mineral.  Organic  matters  in  solution  are  best  treated 
with  potassium  permanganate  or  Condy's  red  fluid.  It 
readily  removes  any  offensive  odour  arising  from  water 
kept  in  casks,  and  oxidises  at  least  a  portion  of  the  organic 
impurities  which  may  be  present ;  but  as  albumen  is  only 
slightly  affected  by  it  without  the  aid  of  heat,  it  cannot 
be  regarded  as  a  reliable  purifier  of  water  tainted  with 
animal  impurities.  Suspicious  waters  should  always  be 
boiled  before  being  used. 

Among  other  purifying  agents  may  be  mentioned, 
distillation,  the  exposure  of  water  in  minute  divided 
currents  to  the  air,  the  immersion  of  pieces  of  charcoal  or 
of  iron  wire,  and  the  effects  of  plants  and  fish.  In  store 
reservoirs,  the  presence  of  a  moderate  quantity  of  living 
plants  exerts  a  decidedly  purifying  influence,  while  the 
destruction  of  fish  has  been  followed  by  an  excessive 
multiplication  of  the  small  crustacean  animals  on  which 
the  fish  had  lived,  thereby  rendering  the  water  nauseous 


164  WATER. 

and  impure.     The  remedy  was  found  in  re-stocking  the 
reservoir  with  fish. — (Eankine.) 


SECTION  V. — SOURCES  OF  POLLUTION. 

Although  reference  has  already  been  made  in  the 
preceding  remarks  to  various  ways  in  which  drinking 
water  becomes  polluted,  it  will  be  expedient  to  consider 
this  important  part  of  the  subject  somewhat  more  fully 
in  detail ;  and  first  with  regard  to  the  water-supply  of 
rural  and  small  urban  districts. 

Estimating  the  town  population  of  Great  Britain  at 
about  fifteen  millions,  the  Kivers  Pollution  Commissioners 
observe  that  "  the  remaining  twelve  millions  of  country 
population  derive  their  water  almost  exclusively  from 
shallow  wells,  and  these  are,  so  far  as  our  experience 
extends,  almost  always  horribly  polluted  by  sewage,  and 
by  animal  matters  of  the  most  disgusting  origin.  The 
common  practice  in  villages,  and  even  in  many  small 
towns,  is  to  dispose  of  the  sewage  and  to  provide  for  the 
water  supply  of  each  cottage,  or  pair  of  cottages,  upon 
the  premises.  In  the  little  yard  or  garden  attached  to 
each  tenement,  or  pair  of  tenements,  two  holes  are  dug 
in  the  porous  soil ;  into  one'  of  these,  usually  the  shallower 
of  the  two,  all  the  filthy  liquids  of  'the  house  are  dis- 
charged ;  from  the  other,  which  is  sunk  below  the  water 
line  of  the  porous  stratum,  the  water  for  drinking  and 
other  domestic  uses  is  pumped.  These  two  holes  are 
not  unfrequently  within  twelve  feet  of  each  other,  and 
sometimes  even  closer.  The  contents  of  the  filth  hole  or 
cesspool  gradually  soak  away  through  the  surrounding 
soil,  and  mingle  with  the  water  below.  As  the  contents 
of  the  water  hole  or  well  are  pumped  out,  they  are 
immediately  replenished  from  the  surrounding  disgusting 
mixture,  and  it  is  not  therefore  very  surprising  to  be 


WATER.  165 

assured  that  such  a  well  does  not  become  dry  even  in 
summer.  Unfortunately,  excrementitious  liquids,  especi- 
ally after  they  have  soaked  through  a  few  feet  of  porous 
soil,  do jnot  impair  the  palatability  of  the  water;  and 
this  polluted  liquid  is  consumed  from  year  to  year  with- 
out a  suspicion  of  its  character,  until  the  cesspool  and 
well  receive  infected  sewage,  and  then  an  outbreak  of 
epidemic  disease  compels  attention  to  the  polluted  water. 
Indeed,  our  acquaintance  with  a  very  large  proportion  of 
this  class  of  potable  waters  has  been  made  in  consequence 
of  the  occurrence  of  severe  outbreaks  of  typhoid  fever 
amongst  the  persons  using  them." — (See  Sixth  Report.) 

Although  it  can  scarcely  be  said  that  this  description 
applies  to  rural  districts  generally,  there  can  be  no  doubt 
that  it  correctly  represents  the  condition  of  the  water- 
supply  of  a  vast  number  of  villages  and  scattered  country 
houses.  Cesspools,  cesspits,  or  drains,  in  close  proximity 
to  wells,  are  a  fruitful  source  of  mischief;  and  so  also 
are  midden-heaps  or  deep  ashpits  connected  with  privies, 
and  the  huge  manure-heaps  which  are  allowed  to  accumu- 
late in  farmyards.  All  such  collections  of  liquid  or  solid 
filth  should  be  regarded  as  dangerous  nuisances,  and 
should  either  be  done  away  with  altogether,  or  such 
adequate  precautions  taken  as  will  obviate  the  risk  of 
soakage  into  the  well.  The  substitution  of  a  dry  system 
of  conservancy  and  the  use  of  pails  or  boxes  for  the  cess- 
pool, common  privy,  and  cesspit,  together  with  better 
scavenging,  would  lessen  to  a  very  large  extent  the 
dangers  of  well-pollution  in  country  districts;  but  in 
crowded  localities  the  soil  becomes  so  saturated  with  filth 
of  all  kinds  that  surface  wells  are  never  safe.  All  pump 
wells  should  be  clay-puddled  to  a  depth  of  eight  or  ten 
feet,  to  keep  out  surface  impurities ;  and  instead  of 
draw  wells  or  shallow  open  dip  wells,  which  are  especially 
liable  to  pollution,  either  proper  pump  wells  should  be 


166  WATER. 

provided,  or,  where  the  nature  of  the  subsoil  is  suitable, 
Norton's  tube  wells  would  be  found  to  possess  many 
advantages.  Surface  wells  near  graveyards  are  very  often 
found  to  be  polluted; 

But  even  when  there  is  no  drain  or  cesspool  near,  a 
well  frequently  becomes  polluted  because  it  is  never 
cleaned  out,  and  for  my  own  part  I  regard  this  periodic 
cleansing  of  wells  so  necessary  that  I  think  every  pump 
well  should  be  provided  with  a  manhole  and  be  cleaned 
out  at  stated  times.  In  towns  or  large  villages  provided 
with  a  public  water-supply,  the  closing  of  all  surface 
wells,  whether  public  or  private,  should  be  rendered  com- 
pulsory ;  for,  with  drains  ramifying  in  every  direction,  it 
may  be  taken  for  granted  that  they  are  either  polluted, 
or  are  at  all  events  constantly  liable  to  pollution. 

With  regard  to  public  supplies,  it  may  be  stated, 
generally,  that  water  may  become  polluted  either  at  its 
source,  in  the  course  of  distribution,  or  through  defects 
connected  with  its  storage.  Any  supply  which  is  taken 
from  a  river  polluted  by  the  sewage  of  towns  up-stream 
must  be  carefully  filtered,  and  even  then  it  can  only  be 
regarded  as  a  suspicious  water.  Deep  wells  or  springs, 
on  the  other  hand,  may  become  polluted  by  the  entrance 
of  surface  impurities,  or  by  the  access  of  polluted  water 
through  open  fissures  in  the  rock.  But  perhaps  the  most 
frequent  and  insidious  sources  of  pollution  to  which 
public  supplies  are  exposed,  are  those  dependent  upon 
the  arrangements  for  distribution  and  storage.  It  has 
already  been  pointed  out  that,  with  an  intermittent  supply, 
the  mains  must  necessarily  become  full  of  air  when  the 
water  is  turned  off,  and  if  at  all  leaky,  as  they  very  often 
are,  they  may  become  charged  with  liquid  as  well  as 
aerial  impurities.  Moreover,  when  water-closets  are 
served  direct  from  the  mains  by  mere  taps  or  stopcocks, 
there  is  always  the  danger  of  liquid  filth  being  sucked 


WATER.  1 6  *7 

into  them  whenever  a  closet-pipe  becomes  choked  up, 
and  the  pan  becomes  full.  The  following  experiment 
will  illustrate  how  readily  such  pollution  may  occur: — 
In  the  report  on  Croydon,  already  referred  to,  Dr.  Buchanan 
states  that  he  had  a  common  house  tap  connected  with  a 
pan  containing  solution  of  burnt  sugar  sufficient  to  colour 
some  thousand  gallons  of  water,  and  that  .in  the  ordinary 
night -intermission  of  supply,  the  whole  of  this  was 
straightway  sucked  into  the  pipes,  and  except  from  one 
neighbour,  was  no  more  heard  of.  He  also  adds  that 
there  is  an  instance  on  record  of  bloody  water  coming 
from  the  main  tap  of  a  house  situated  next  to  a  slaughter- 
house. Then,  too,  connected  with  this  system  of  inter- 
mittent supply,  there  are  all  the  risks  of  contamination 
attaching  to  cisternage,  or  storage  in  pails,  butts,  or  other 
receptacles.  If  the  same  cistern  is  used  to  supply  the 
house  and  the  water-closet  as  well,  sewer -gases  from 
the  closet  have  access  to  the  surface  of  the  water  in  the 
cistern;  or  should  the  overflow  pipe  from  the  house 
cistern  discharge  direct  into  a  sewer  or  drain,  there  is  of 
course  the  same  danger.  Apart  also  from  the  risk  of 
lead-pollution  from  leaden  cisterns,  the  water  stored  in  a 
cistern  may  eventually  become  unfit  for  use,  because  the 
cistern  is  seldom  or  never  cleaned  out. 

But  even  with  a  constant  supply  there  appear  to  be 
certain  dangers  depending  upon  possible  in-currents  from 
leaky  mains,  especially  when  these  are  in  juxtaposition 
to  sewers  or  drains  which  have  hitherto  escaped  the 
notice  of  engineers.  The  physical  conditions  under 
which  such  in-currents  may  take  place  have  been  in- 
vestigated to  a  certain  extent  by  Dr.  Buchanan,  and  I 
quote  his  results  here,  in  order  that  others  may  be  induced 
to  make  experiments  in  the  same  direction.  In  a  note 
appended  to  the  Croydon  report  he  gives  the  following 
summary  of  results  : — "  I  find  (1)  the  lateral  in-current 


168  WATER. 

is  freely  produced  when  the  water-pipe  is  descending,  and 
when  the  pipe  beyond  the  hole  is  unobstructed ;  (2)  if 
the  force  of  water-flow  in  a  descending  pipe  be  moderate, 
a  moderate  degree  of  obstruction  beyond  the  hole  does 
not  prevent  the  in-current ;  (3)  in  horizontal  pipes  of 
uniform  calibre,  when  the  flow  is  strong,  or  the  pipe 
beyond  the  hole  is  long,  or  when  the  end  of  the  pipe 
is  at  all  turned  upwards,  the  in-current  does  not  take 
place,  but  (4)  momentary  interference  with  flow  a  tergo, 
or  momentary  reduction  of  obstruction  a  fronte,  allows  of 
a  momentary  in-current  through  the  hole ;  (5)  in-current 
through  a  lateral  hole  takes  place  with  incomparably 
greater  ease  when  the  hole  is  made  at  a  point  of  con- 
striction of  the  water-pipe." 

It  has  further  to  be  observed  that  water  mains,  if 
not  sufficiently  protected  against  corrosion,  may  render 
the  water  turbid,  owing  to  rusting  of  the  iron ;  that  the 
tow  or  gaskin  employed  to  caulk  joints  may  taint  the 
water  for  a  long  period  if  the  main  is  several  miles  in 
length ;  and  that  leaden  pipes,  especially  when  first  laid 
down,  may  become  a  source  of  danger  if  the  water  is  soft. 

With  regard  to  the  general  effects  of  drinking  impure 
water,  and  particular  outbreaks  of  disease  depending  upon 
ascertained  sources  of  pollution,  see  Chapter  VIII. 


WATER  ANALYSIS.  169 


CHAPTEE   VII. 

WATER  ANALYSIS. 

SECTION  I. — COLLECTION  OF  SAMPLES. 

IN  collecting  water  for  analytical  purposes,  and  parti- 
cularly when  it  is  intended  to  submit  samples  to  a 
quantitative  analysis,  the  following  directions  should  be 
observed  : — An  ordinary  glass-stoppered  Winchester  quart 
bottle  will  answer  very  well  for  the  conveyance  of  the 
water.  It  should  be  cleaned  out  with  strong  sulphuric 
acid,  then  rinsed  with  ordinary  good  water  until  the  rinsings 
are  no  longer  acid,  and  finally  washed  out  with  some  of 
the  water  to  be  examined.  The  bottle  should  be  filled 
almost  up  to  the  neck,  stoppered,  and  the  stopper  covered 
over  with  a  piece  of  clean  calico,  wash  leather,  or  gutta 
percha  tissue,  tied,  and  sealed.  No  luting  should  be 
used  except  sealing-wax,  and  even  that  should  be  dis- 
pensed with  if  possible.  If  the  water  contains  organic 
matter,  it  should  be  examined  at  least  within  forty-eight 
hours  after  being  collected. 

In  collecting  pond  or  lake  water  the  bottle  should  be 
plunged  into  the  water  as  far.  as  possible  from  the  bank, 
with  the  mouth  well  under  the  surface,  so  as  to  avoid  the 
scum,  care  being  taken,  at  the  same  time,  that  the  mud 
at  the  bottom  is  not  disturbed.  If  the  sample  is  taken 
from  a  town  supply,  it  should,  if  possible,  be  collected 
direct  from  the  mains,  or  from  the  water-jets  at  the  cab- 


1  7  0  WATER  ANALYSIS. 

stands  or  public  fountains,  in  which  case  the  water  should 
be  allowed  to  flow  for  some  time  previous  to  filling  the 
bottle.  If  taken  from  a  house  service -tap,  the  water 
should  also  be  allowed  to  flow  for  some  time  before  col- 
lecting. With  regard  to  river  water,  it  is  recommended 
to  select  the  middle  of  the  stream,  to  avoid  the  outlets  of 
sewers  and  feeders,  and  to  note  whether  there  has  been 
previously  a  heavy  fall  of  rain  or  a  long  drought.  When 
a  sample  is  required  from,  the  source  of  a  spring,  it  is 
sometimes  necessary  to  dig  a  small  excavation  and  allow 
all  sediment  to  subside  before  the  sample  is  taken.  Well- 
water  should  of  course  be  drawn  direct  from  the  well. 

Different  methods  of  examination  require  different 
quantities ;  for  Mr.  Wanklyn's  method  one  Winchester 
quart  will  be  quite  sufficient,  but  for  a  complete  investiga- 
tion some  analysts  require  about  a  gallon.  If  a  Winchester 
quart  cannot  readily  be  procured,  a  clear  glass  wine  bottle 
will  answer  very  well,  but  care  must  be  taken  to  have  it 
thoroughly  clean,  and  the  cork  should  be  clean  and  new, 
and  fit  well. 

The  medical  officer  of  health  will  find  it  very  con- 
venient to  have  a  basket  containing  two  or  more  clear 
glass  -  stoppered  bottles  placed  under  the  charge  of  the 
sanitary  inspector  of  the  district.  The  basket  should  be 
provided  with  a  padlock  fitted  with  two  keys,  one  of  which 
should  be  in  the  possession  of  the  medical  officer  of  health 
and  the  other  retained  by  the  inspector.  Before  forward- 
ing the  bottles,  the  inspector  should  affix  a  label  to  each, 
containing  the  date  and  a  distinctive  number,  or  certain 
particulars  with  regard  to-  the  source  of  the  water  and 
why  it  is  suspected.  For  ordinary  analysis  pint  stoppered 
bottles  will  be  found  to  be  large  enough,  because,  should 
a  greater  quantity  be  required  at  any  time,  two  bottles 
can  be  used  instead  of  one. 


WATER  ANALYSIS. 


SECTION  II. — PHYSICAL  EXAMINATION. 

A  portion  of  the  sample  collected  should  be  poured, 
after  shaking  the  bottle,  into  a  good-sized  clear  glass  flask. 
If  the  flask  is  then  held  in  front  of  a  dark-coloured  surface, 
with  a  good  light  falling  on  the  side  or  from  above,  any 
suspended  impurities  will  become  visible,  but  care  should 
be  taken  to  discriminate  between  them  and  air-bubbles. 

Colour  and  turbidity  are  best  ascertained  by  pouring 
the  water  into  a  tall  vessel  of  colourless  glass,  and  placing 
it  upon  a  porcelain  slab  or  piece  of  white  paper.  Another 
glass  of  the  same  dimensions,  filled  with  distilled  water, 
should  be  placed  by  its  side  for  comparison.  Both 
samples  are  then  looked  through  from  above,  and  the 
difference  between  them  noted.  If  organic  matter  is  pre- 
sent, the  water  has  usually  a  tinge  of  yellow,  green,  or 
blue,  but  mineral  substances  may  give  similar  indications. 
Clay,  peat,  and  other  harmless  contaminations  impart  a 
brownish  tint.  If  the  turbidity  is  considerable,  or  if  the 
water  is  very  dark  in  colour,  it  may  be  pronounced 
unfit  for  use,  although  filtration  may  render  it  perfectly 
wholesome. 

To  observe  the  smell  of  the  water,  a  portion  of  it 
should  be  poured  into  a  wide-mouthed  flask,  making  it 
about  one-third  full,  and  then  shaking  it  well.  If  the 
smell  is  unpleasant,  the  water  is  unfit  to  drink.  Should 
no  smell  be  detected,  the  flask  should  be  heated,  and  the 
water  again  shaken,  and  if  there  is  still  no  smell  a  little 
caustic  potash  should  be  added  to  the  warm  water.  Any 
unpleasant  odour  which  may  now  be  given  off  indicates 
with  tolerable  certainty  that  the  water  contains  organic 
impurities  in  considerable  quantity.  The  occurrence  of  a 
precipitate  on  the  addition  of  the  caustic  potash  will  at 
the  same  time  indicate  hardness. 


172  WATER  ANALYSIS. 

With  regard  to  taste,  it  is  sufficient  to  say  that  a  badly- 
tasting  water  should  be  condemned  for  drinking  purposes. 
Many  waters,  however,  which  are  largely  impregnated 
with  dissolved  animal  impurities  may  be  quite  palatable. 

Altogether,  the  physical  examination  of  water  is  of 
a  negative  character ;  and  although  it  may  impart  some 
useful  information,  it  cannot  be  relied  upon  in  arriving  at 
a  sound  conclusion  as  regards  the  good  or  bad  qualities  of 
any  given  sample. 

SECTION  III. — MICROSCOPICAL  EXAMINATION. 

In  order  to  collect  the  sediment  the  water  should  be 
poured  into  a  large  depositing-glass,  and  allowed  to  stand 
for  12  or  24  hours.  Particles  of  sand  are  recognised  by 
their  angular  shapes,  and  by  their  not  being  affected  by 
acids.  Particles  of  clay  and  marl  are  amorphous,  and  are 
also  unaffected  by  acids.  Particles  of  chalk  are  amorphous, 
and  are  readily  dissolved  by  acids.  Dead  vegetable  matter, 
such  as  woody  fibre  and  portions  of  leaves,  and  living  vege- 
table matter,  consisting  of  confervoid  growths,  may  all  be 
detected  in  water  which  cannot  be  pronounced  unwhole- 
some. So  also  may  diatomacece,  infusoria,  and  entomostraca. 
Microscopical  examination,  therefore,  is  only  valuable  for 
practical  purposes,  in  so  far  as  it  indicates  the  various 
components  of  the  suspended  matters ;  it  gives  no  direct 
information  concerning  the  presence  of  dissolved  organic 
impurities.  There  is  no  doubt,  however,  that  it  presents 
a  wide  and  interesting  field  for  research,  and  in  this 
respect  the  writings  of  Drs.  Burdon  Sanderson,  Cohn,  and 
Macdonald  of  Netley,  are  extremely  valuable.  Eeference 
should  also  be  made  to  Koch's  gelatine  process,  as  recently 
explained  by  Dr.  Angus  Smith,  which  appears  to  be  full 
of  promise,  and  to  indicate  a  new  departure  in  water- 
analysis. — (See  Sanitary  fiecord,  1883.) 


WATER  ANALYSIS.  173 


SECTION  IV. — CHEMICAL  EXAMINATION. 

This  may  be  either  qualitative  or  quantitative.  For 
ordinary  purposes,  as,  for  example,  in  the  discharge  of  a 
medical  officer  of  health's  duties  in  rural  districts,  a  quali- 
tative examination,  if  judiciously  conducted,  will  be  found 
to  be  quite  sufficient  to  enable  him  to  give  a  reliable 
opinion  as  to  whether  a  water  is  fit  for  use  or  not  in  the 
great  majority  of  instances,  provided  the  water  is  not 
specifically  polluted.  But,  in  all  cases  in  which  qualita- 
tive tests  indicate  that  a  water  is  doubtful  or  suspicious, 
and  in  cases  which  are  likely  to  lead  to  magisterial  pro- 
ceedings, it  is  necessary  to  submit  the  sample  to  a  quan- 
titative analysis  more  or  less  complete.  A  quantitative 
analysis  is  also  required  in  the  examination  of  public 
supplies,  and  in  the  case  of  any  proposed  new  public 
supply  it  should  be  thorough  in  all  its  details. 

But  the  main  object  which  the  sanitarian  has  in  view 
is  to  determine  whether  or  not  any  given  water  is  dan- 
gerously contaminated  with  organic  matter,  and  this,  as  I 
have  already  said,  may  be  ascertained  in  the  great  ma- 
jority of  instances  by  a  qualitative  examination.  After 
noting  the  various  indications  obtained  from  the  physical 
i-xamination  previously  described,  and  taking  care  that 
all  test-tubes,  test -glasses,  measures,  and  the  like,  are 
thoroughly  clean  and  conveniently  arranged,  the  qualita- 
tive testing  of  one  or  more  samples  may  be  readily  con- 
d-.cted  as  follows: — 


1.   Qualitative  Examination. 

(1.)  Ammonia. — Fill  an  ordinary  test-tube  of  about 
1  oz.  in  capacity  nearly  full  with  the  water  to  be 
examined,  and  add  3  or  4  minims  of  the  Nessler  re- 


174  WATER  ANALYSIS. 

agent.  If  a  yellow  or  brown  colour,  or  a  brownish  pre- 
cipitate, be  produced,  the  water  contains  ammoniacal  salts. 
As  a  rule,  this  should  be  regarded  as  a  very  suspicious 
circumstance,  and  should  the  coloration  be  well  marked, 
it  is  almost  sufficient  of  itself  to  condemn  the  water  for 
drinking  purposes.  A  milky  or  curdy-looking  precipitate 
will  also  indicate  that  the  water  is  hard.  If  the  precipi- 
tate is  excessive,  it  masks,  to  a  certain  extent,  the  colour 
indicative  of  the  test,  in  which  case  it  is  advisable  to  take 
a  fresh  sample  in  another  test-tube,  add  a  few  drops  of  a 
strong  solution  of  caustic  potash,  and  after  the  precipitate 
which  is  thus  formed  subsides,  add  the  Nessler  re-agent. 
(2.)  Nitrites. — Fill  an  average-sized  test-glass  about 
three  parts  full  of  the  water  to  be  examined,  then  add  5 
minims  of  pure  sulphuric  acid  and  5  minims  of  a  solution 
of  potassium  iodide  (5  grs.  to  1  oz.  distilled  water),  and 
afterwards  pour  in  a  small  quantity  of  freshly-prepared 
starch  solution.  The  solution  is  readily  prepared  by  boil- 
ing a  small  quantity  of  starch  powder  in  a  vessel  contain- 
ing distilled  water.  A  blue  tint  indicates  nitrites,  and 
should  the  colour  be  at  all  deep  the  water  is  scarcely  fit 
to  drink.  As  iodide  of  potassium  sometimes  contains 
iodate,  it  is  always  advisable  to  make  a  comparative  ex- 
periment either  with  distilled  water  or  with  a  water  which 
is  known  not  to  contain  nitrites.  Instead  of  the  sulphuric 
acid,  acetic  acid  may  be  used,  and  the  starch  paste,  potas- 
sium iodide,  and  acid,  may  be  mixed  before  adding  the 
solution  to  the  water. 

•  (3.)  Nitrates. — The  readiest  method  of  testing  for 
nitrates  is  that  known  as  Horsley's  test,  of  which  the  fol- 
lowing modification  has  been  proposed  by  Dr.  Bond  of 
Gloucester : — Put  2  0  minims  of  pure  sulphuric  acid  into 
a  very  small  test-tube,  then  add  10  minims  of  the  water 
to  be  examined,  and  afterwards  drop  in  carefully  1  drop 
of  a  solution  of  pyro-gallic  acid  (10  grs.  to  1  oz.  distilled 


WATER  ANALYSIS.  1*75 

water  acidulated  with  2  drops  of  sulphuric  acid).  A  pink 
zone,  or  sometimes  a  delicate  blue  zone  changing  into  a 
dark  amethyst  tint,  and  from  that  into  a  brown  tint,  indi- 
cates nitrates.  When  shaken  up,  the  greater  part  of  this 
coloration  may  disappear  for  a  time,  but  it  gradually 
returns,  and  after  the  mixture  has  stood  for  a  few  hours 
a  permanent  tint  is  developed. 

The  detection  of  nitrates  in  a  water  derived  from  a 
deep  well  is  no  evidence  of  sewage  contamination,  because, 
as  in  the  chalk  formation,  they  may  be  derived  from  the 
strata  through  which  the  water  passes,  but  in  surface  or 
shallow  well  waters  their  presence  may  fairly  be  regarded 
as  a  suspicious  circumstance. 

(4.)  Chlorides. — The  amount  of  chlorine  in  water  can 
be  determined  so  quickly  by  a  simple  volumetric  method, 
which  will  be  subsequently  described,  that  those  who  are 
provided  with  the  test-solution  of  nitrate  of  silver  should 
always  adopt  this  method;  but  to  those  who  have  not  this 
test -solution  the  following  method  is  recommended: — 
Acidulate  a  little  of  the  water  in  a  test-glass  with  a  few 
drops  of  dilute  nitric  acid,  and  add  in  excess  a  solution  of 
nitrate  of  silver.  Four  grains  per  gallon  of  sodium  chloride 
give  a  turbidity;  10  grains  a  slight  precipitate;  and  20 
grains  a  considerable  precipitate,  soluble  in  ammonia.  A 
good  water  should  only  yield  a  slight  haziness.  If  there 
is  a  distinct  precipitate,  it  shows  that  the  water  is  derived 
from  a  formation  rich  in  salt,  such  as  the  new  red  sand- 
stone, that  it  is  brackish  if  on  the  sea- coast,  or  that  it  has 
been  contaminated  with  sewage.  In  the  first  two  cases 
there  will  be  a  large  amount  of  mineral  solids,  and  there- 
fore, in  the  case  of  a  soft  water,  any  excess  of  chlorides 
would  point  to  sewage  contamination.  On  the  other  hand, 
it  is  important  to  note  that  the  absence  of  chlorides  from 
a  sample  of  water  renders  it  very  probable  that  it  is  free 
from  sewage  contamination. 


176  WATER  ANALYSIS. 

(5.)  Lead  and  Iron. — Boil  between  3  and  4  oz.  of  the 
water  acidulated  with  a  few  drops  of  sulphuric  acid,  and 
afterwards  add  sulphuretted  hydrogen  water.  If  a  brown 
or  blackish  coloration  is  produced,  the  presence  of  lead 
may  be  inferred.  If  no  colour  can  be  detected,  add  a 
little  potash  or  ammonia,  and  if  this  produces  a  blackish 
precipitate,  iron  is  almost  certain  to  be  present.  Small 
traces  of  iron  in  a  water  cannot  be  considered  injurious, 
but  the  presence  of  lead  is  sufficient  to  condemn  the  water 
as  unfit  for  use. 

(6.)  Organic  Matter. — Although  the  permanganate  of 
potash  test  has  of  late  years  fallen  into  disfavour  with 
many  analysts  on  account  of  its  indefinitiveness,  I  am  still 
of  opinion  that  it  may  be  employed  with  considerable 
advantage  in  the  qualitative  examination  of  surface- well 
waters,  and  particularly  in  localities  where  salts  of  iron 
are  not  usually  found.  The  following  is  a  convenient 
method  of  applying  the  test : — Fill  a  tall  colourless  glass 
vessel  or  test-tube  nearly  full  with  the  water  to  be  exam- 
ined, and  add  as  much  solution  of  potassium  permanganate 
(2  grs.  to  4  oz.  distilled  water)  as  will  impart  a  distinct 
pink  tinge  after  stirring  with  a  glass  rod.  Then  fill 
another  glass  cylinder  or  test-tube  of  the  same  size  with 
distilled  water,  and  add  the  same  quantity  of  perman- 
ganate solution.  Place  the  two  glasses  side  by  side  on  a 
white  sheet  of  paper  or  porcelain  slab,  and  note  any  differ- 
ences between  the  two  tints  which  may  speedily  or  sub- 
sequently take  place.  If  decoloration  takes  place  rapidly, 
or  sets  in  -gradually,  it  shows  that  the  water  contains 
oxidisable  organic  matter,  iron,  nitrites,  or  sulphuretted 
hydrogen.  The  last  of  these  is  rarely  found,  and  would 
be  distinguished  by  the  smell,  while  the  presence  of  iron 
or  nitrites  can  be  ascertained  by  tests  already  described. 
In  the  absence  of  these  three  any  rapid  decoloration  indi- 
cates that  the  organic  matter  is  of  animal  origin,  whereas 


WATER  ANALYSIS.  1 

slower  changes  indicate  that  vegetable  matter  is  present. 
With  these  limitations,  and  with  a  general  knowledge  of 
the  geological  characteristics  of  the  well-waters  of  a  dis- 
trict, the  test  may  be  advantageously  employed  as  a  con- 
firmatory test,  though  it  cannot  always  be  relied  on  when 
it  gives  negative  results. 

By  a  judicious  application  of  some  or  all  of  these 
tests  the  medical  officer  of  health  can  examine  several 
samples  of  water  in  a  comparatively  short  space  of  time ; 
but,  in  order  to  conduct  the  examination  systematically,  he 
ought  to  arrange  the  test  tubes  or  glasses  in  separate  sets, 
and  number  them  according  to  the  samples.  These,  it  is 
presumed,  are  all  derived  from  surface  or  shallow  well 
waters,  and  the  'following  indications  will  enable  him  to 
decide  as  to  whether  the  water  is  fit  for  use  or  not,  or 
whether  it  is  of  doubtful  purity,  in  which  case  it  should 
be  submitted  to  a  quantitative  analysis  : — 

If  the  water  contains  a  considerable  amount  of  sedi- 
ment, and  is  found  when  decanted  off  or  filtered  to  show 
little  or  no  traces  of  ammonia,  nitrates,  or  chlorides,  it 
shows  that  it  is  fit  for  use,  but  the  well  requires  cleaning 
out ;  or,  should  the  well  be  a  tube  well,  that  it  ought  to 
be  filtered.  If  the  sediment  is  flocculent  and  dirty-looking, 
it  will  generally  be  found  that  the  water  is  polluted  in 
other  respects,  and  an  order  should  be  given  that  the  well 
should  be  opened,  examined,  and  cleaned  out,  and  any 
ascertained  source  of  pollution  removed.  In  towns  or 
villages  where  there  is  a  public  water-supply,  and  the 
premises  are  within  easy  reach  of  a  water-main,  there 
should  be  no  hesitation  in  requiring  the  well  to  be  closed  ; 
or  if  the  ground  is  so  saturated  with  filth  that  it  is  hope- 
less to  expect  that  any  alterations  can  ensure  subsequent 
safety,  an  order  to  close  the  well  should  still  be  insisted 
on.  But  supposing  the  water  is  tolerably  clear,  or  quite 
clear,  what  are  the  inferences  to  be  drawn  from  the  quali- 


178  WATER  ANALYSIS. 

tative  examination  ?  If  there  is  distinct  coloration  on  the 
addition  of  the  Nessler  re-agent,  but  very  little  precipitate, 
and  with  no  distinct  indications  of  either  nitrites,  nitrates, 
or  chlorides,  it  shows  that  the  water  is  a  soft  water  and 
fit  for  use,  and  that  the  ammonia  is  either  derived  from 
rain  water  or  is  probably  of  vegetable  origin.  If  ammonia, 
nitrites,  and  chlorides  in  excess  are  all  present,  the  water 
is  polluted  and  unfit  for  use.  A  water  with  no  great 
excess  of  chlorides,  and  which  yields  a  large  flocculent 
precipitate  on  the  addition  of  the  Nessler  re-agent,  but 
does  not  become  tinted,  and  gives  no  indication  of  the 
presence  of  nitrites,  nitrates,  or  organic  matter,  is  a  hard 
water,  but  otherwise  fit  for  use.  Should  a  water  contain 
nitrates  and  traces  of  nitrites,  but  give  no  distinct  indica- 
tion of  ammonia  or  chlorides,  it  may  be  considered  fit  for 
use.  If  nitrites  and  chlorides  are  both  present  in  any 
excess,  the  water  should  be  regarded  as  a  very  suspicious 
water,  and  be  submitted  to  a  more  careful  examination, 
even  though  the  Nessler  re-agent  should  produce  no  dis- 
tinct coloration.  But  it  should  always  be  remembered 
that  chemical  analysis,  however  complete,  can  only  indicate 
danger  when  palpably  present,  but  it  is  powerless  to 
indicate  any  standard  of  safety  when  a  water  becomes 
specifically  polluted. 

In  giving  instructions  as  to  what  action  should  be 
taken  when  a  sample  of  well-water  is  found  to  be  polluted, 
it  is  always  advisable,  when  there  is  no  public  supply 
within  reach,  to  recommend  that  the  well  should  be 
opened  and  examined.  The  pollution  may  arise  from 
want  of  cleansing,  or  from  leakage  from  a  drain,  cesspool, 
or  farmyard,  and  it  will  depend  upon  the  special  circum- 
stances of  the  case  as  to  whether  cleansing  and  removal 
of  the  source  of  pollution  will  suffice,  or  whether  the  well 
should  be  closed  altogether,  and  a  new  one  sunk  in  some 
other  suitable  place  where  there  is  no  risk  of  pollution. 


WATER  ANALYSIS.  1*79 

It  is  evident  therefore  that  detailed  information  with 
regard  to  the  situation  and  surroundings  of  a  polluted  well 
is  of  very  material  service  in  advising  as  to  what  particu- 
lar steps  should  be  taken ;  but,  so  far  as  the  water  itself 
is  concerned,  the  medical  officer  of  health  need  only  report 
that  it  is  contaminated  and  unfit  for  use.  Should  his 
recommendations,  when  notified  in  the  regular  way  by  the 
sanitary  inspector,  not  be  complied  with,  it  may  become 
necessary  to  submit  the  water  in  question  to  a  quantita- 
tive analysis,  in  order  to  obtain  a  magistrate's  order  to 
cleanse,  repair,  or  close  the  well,  as  the  case  may  be. 

2.   Quantitative  Analysis. 

With  the  exception  of  proposed  new  public  supplies, 
which  should  in  all  cases  be  submitted  to  a  very  minute 
analysis,  the  only  points  which  require  determination  in 
an  ordinary  quantitative  analysis  are  the  total  solids,  the 
hardness,  the  chlorides,  and  the  organic  matter  as  repre- 
sented by  the  free  and  albuminoid  ammonia. 

(1.)  Total  Solids. — The  amount  of  total  solids  is 
ascertained  by  evaporating  a  known  portion  of  the  water 
to  be  examined  to  dryness.  Into  a  platinum  dish  which 
has  been  carefully  cleaned,  dried,  and  weighed,  pour  70 
cubic  centimetres  of  the  sample  of  water ;  place  the  dish 
in  the  water  or  steam -bath,  and  evaporate  to  dryness, 
then  wipe  the  dish  externally,  and  weigh.  The  difference 
between  the  two  weighings  gives  the  weight  of  the  residue 
yielded  by  70  cubic  centimetres  of  water.  Seventy  c.  c. 
are  taken,  because  each  milligramme  of  residue  counts  for 
one  grain  of  total  residue  in  a  gallon  of  water,  inasmuch 
as  a  gallon  of  water  weighs  70,000  grains,  and  70  c.  c. 
weigh  70,000  milligrammes. 

If  the  operator  has  a  very  delicate  balance,  and  has 
had.  some  experience  in  chemical  manipulation,  25  c.  c. 


180  WATER  ANALYSIS. 

of  the  water  to  be  examined  will  usually  be  found  suffi- 
cient, but  in  that  case  the  result  in  milligrammes  must 
be  multiplied  by  2 '8  (4  X  *7)  in  order  to  obtain  the  total 
amount  of  residue  in  grains  per  gallon.  Thus,  to  take 
the  following  example  : — 

Weight  of  dish          .         .         .         24 -286  grammes. 
„         dish  and  residue        .         24*295         ,, 

Therefore  weight  of  residue  =          '009        ,, 

But  "009  grammes  are  9  milligrammes,  and  multiplying 
this  number  by  2*8  gives  2 5 '2  grains  as  the  amount  of 
solid  residue  in  a  gallon  of  the  water  examined.  If  1 0  0 
c.  c.  are  taken,  the  multiple  will  of  course  be  *7.  The 
times  occupied  in  the  evaporation  average  about  two  hours 
for  the  100  c.  c.,  an  hour  and  a  quarter  for  the  70  c.  c., 
and  about  half  an  hour  when  only  25  c.  c.  are  evaporated. 
In  drying  the  residue,  the  dish  should  be  put  into  a  hot- 
air  bath,  then  allowed  to  cool,  and  weighed  promptly 
afterwards  to  avoid  deliquescence  of  the  salts. 

A  very  cheap  and  efficient  steam -bath  can  be  made 
from  a  pint  oil -can  by  fitting  it  with  a  cork  which  is 
perforated  to  admit  the  stem  of  an  ordinary  glass  funnel. 
The  can  is  partly  filled  with  water,  and  fixed  on  a  retort 
stand,  and  the  platinum  dish  is  placed  in  the  mouth  of 
the  funnel  with  a  piece  of  folded  paper  between  to  permit 
the  escape  of  the  steam. 

The  total  solid  residue  consists  for  the  most  part  of 
mineral  matter,  and  in  many  waters  this  is  composed 
chiefly  of  carbonate  of  lime.  It  is  difficult  to  fix  the 
maximum  amount  of  permissible  solid  residue  in  drinking 
water.  In  public  supplies  it  certainly  ought  not,  if  pos- 
sible, to  exceed  30  grains  per  gallon,  but  many  usable 
well-waters  are  found  to  contain  double  this  amount. 

The  following  are  examples  of  the  amount  of  solids 
in  different  waters  : — 


WATEE  ANALYSIS.  181 

Grains  per  Gallon. 
Loch  Katrine  .         .         .         .         .  2 '30 

Bala  Lake 3'18 

London  Thames  Companies  ...  21  *66 
Rochdale  Spring  ....'.  25 '93 
Norwich  Artesian  well  .  .  .  .  26  70 

If  a  complete  quantitative  analysis  of  the  saline  con- 
stituents is  required,  a  much  larger  quantity  of  water  must 
be  evaporated,  but  the  presence  and  amount  of  the  more 
important  constituents  may  be  approximately  determined 
as  follows : — 

a.  (Lime.) — Pour  a  little  of  the  water  into  a  test- 
glass,  and  add  a  solution  of  ammonium  oxalate.  Six 
grains  of  lime  per  gallon  will  yield  a  slight  turbidity ; 
1 6  grains  a  distinct  precipitate ;  and  3  0  grains  a  large 
precipitate,  soluble  in  nitric  acid. 

1.  (Magnesia.) — In  a  good  water  there  should  only 
be  a  slight  haziness,  or  none  at  all,  on  the  addition  of 
ammonia. 

c.  (Sulphates.) — Acidulate  with  a  few  drops  of  hydro- 
chloric acid  and  add  a  solution  of  barium  nitrate.  A 
good  water  should  not  give  more  than  a  slight  haziness. 

It  is  seldom,  however,  that  these  subsidiary  tests  are 
required.  A  more  important  indication  is  obtained  by 
incinerating  the  residue  over  a  flame,  when,  if  blackening 
occurs,  the  presence  of  organic  impurities  may  be  inferred, 
and  should  a  bad  smell  be  given  off  at  the  same  time,  it 
is  almost  certain  to  be  derived  from  impurities  of  animal 
origin. 

(2.)  Hardness. — It  has  already  been  pointed  out  that 
a  water  is  hard  or  soft  according  to  the  amount  of  solid  ,  ( 
residue  which  it  contains.  Thus  a  water  which  contains 
only  three  to  four  grains  of  residue,  such  as  the  Loch 
Katrine  water,  is  an  exceedingly  soft  water ;  a  water 
containing  eight  to  ten  grains  is  a  moderately  soft  water; 
while  those  which  contain  twenty  grains  and  upwards  are 


182  WATER  ANALYSIS. 

hard  waters.  For  purely  sanitary  purposes,  therefore,  the 
determination  of  the  hardness  is  seldom  required,  if  the 
total  solid  residue  has  been  ascertained.  The  hardness 
of  a  water  is  due  to  the  presence  of  earthy  salts,  generally 
carbonate  of  lime  and  sulphate  of  lime  and  magnesia. 
The  former  is  deposited  on  boiling,  and  is  represented  by 
what  is  called  the  removable  hardness,  while  the  latter, 
inasmuch  as  it  is  not  affected  by  boiling,  is  called  the 
permanent  hardness.  The  rationale  of  the  process,  as 
.  first  explained  by  the  late  Professor  Clark,  will  be  under- 
*  stood  when  it  is  remembered  that  if  an  alkaline  oleate, 
such  as  soap,  is  mixed  with  pure  water,  a  lather  is  formed 
almost  immediately;  but  if  salts  of  lime,  magnesia,  baryta, 
iron,  or  alumina  are  present,  oleates  of  jthese  bases  are 
formed,  and  no  lather  is  given  until_the  earthy  bases  are 
thrown  down.  As  the  soap  will  combine  in  equivalent 
proportions  with  these  bases,  it  is  only  necessary  to  make 
the  solution  of  soap  of  known  strength  by  standardising 
it  with  a  known  quantity,  say  of  chloride  of  calcium,  to 
be  able  to  determine  the  amount  of  lime  or  its  equivalent 
of  other  salts  in  the  water — so  much  soap  required  before 
a  lather  is  produced  represents  so  many  degrees  of  hard- 
ness. The  standard  solutions  are  prepared  and  deter- 
mined according  to  the  following  method,  proposed  by 
Messrs.  Wanklyn  and  Chapman : — Make  a  solution  of 
pure  calcium  chloride  of  I'llO  grammes  to  the  litre  of 
distilled  water.  Each  cubic  centimetre  of  this  solution 
contains  an  amount  of  calcium  chloride  equal  to  one 
milligramme  of  carbonate  of  lime.  The  standard  soap 
test  is  made  by  pounding  together  two  parts  of  lead 
plaister  with  one  of  carbonate  of  potash,  exhausting  re- 
peatedly with  alcohol  at  90  per  cent,  and  using  about 
thirty  times  as  much  alcohol  as  lead  plaister.  This 
solution  is  allowed  to  stand  for  some  time,  and  is  then 
filtered,  and  afterwards  diluted  with  its  own  volume  of 


WATER  ANALYSIS.  183 

water.  In  order  to  standardise  it  10  c.  c.  are  taken  and 
put  into  a  bottle  with  70  c.  c.  of  pure  water  ;  the  chloride 
of  calcium  solution  is  now  added  until  frothing  stops, 
care  being  taken  to  shake  properly;  and  from  this  trial 
experiment  it  is  easy  to  calculate  how  much  dilution  of 
the  soap  solution  is  requisite  in  order  to  make  1*7  c.  c.  of 
the  soap-test  use  up  16  c.  c.  of  the  chloride  of  calcium 
solution.  The  dilution  should  be  made  with  alcohol  of 
50  per  cent,  and  the  soap  test  carefully  verified  after  it 
has  been  made  up.  This  is  done  by  adding  16  c.  c.  of 
the  standard  solution  of  calcium  chloride  to  54  c.  c.  of 
distilled  water,  thus  making  a  solution  of  70  c.  c.,  which 
should  exactly  be  neutralised  by  17  c.  c.  of  the  standard 
soap-test. 

A  much  easier  method  of  making  the  soap  test,  and 
one  which  gives  fairly  accurate  results,  is  to  dissolve  ten 
grammes  of  green  Castile  soap  in  a  litre  of  weak  alcohol  of 
about  3  5  per  cent.  One  cubic  centimetre  of  this  solution 
also  precipitates  one  milligramme  of  carbonate  of  lime. 
Either  solution,  therefore,  may  be  used,  and  the  mode  of 
employing  the  test  is  as  follows  : — 

Into  a  clear  glass-stoppered  bottle,  capable  of  holding 
about  250  c.  c.  put  70  c.  c.  of  the  water.  Add  slowly 
from  a  burette  the  standard  soap  solution,  and  shake  well 
until  a  persistent  lather  is  formed,  noting  accurately  the 
amount  of  solution  used.  Each  c.  c.  of  the  solution  con- 
sumed indicates  one  grain  of  carbonate  of  lime  or  its 
equivalent  in  a  gallon  of  water.  If,  after  adding  17  c.  c. 
of  the  solution,  no  lather  is  formed,  add  70*c.  c.  of  dis- 
tilled water  and  mix,  and  continue  the  addition  of  the 
soap  solution.  Should  no  lather  be  formed  until  other 
17  c.  c.  are  consumed,  other  70  c.  c.  of  distilled  water 
must  be  added,  but  in  making  the  calculation  for  hard- 
ness, 1  must  be  deducted  from  the  number  of  c.  c.  of  soap 
solution  used  for  each  70  c.  c.  of  water  which  have  been 


184  WATER  ANALYSIS. 

added,  and  this  deduction  is  necessary  because  70  c.  c. 
of  distilled  water  would  themselves  neutralise  about  1 
c.  c.  of  soap  test.  Suppose,  for  example,  that  18  c.  c.  of 
soap  solution  have  been  required,  then  1  must  be  deducted 
from  the  70  c.  c.  of  distilled  water  which  were  added,  and 
the  hardness  of  the  sample  in  question  is  put  down  as  1 7 
degrees.  In  other  words,  the  total  soap-destroying  power 
of  the  water  is  equivalent  to  17  grains  of  carbonate  of 
lime  per  gallon.  The  permanent  hardness  is  obtained  by 
boiling  70  c.  c.  of  the  water  for  about  an  hour,  and 
making  up  the  loss  by  evaporation  with  distilled  water. 
During  boiling,  the  bicarbonate  of  lime  is  decomposed 
and  the  carbonate  deposited,  and  thus  the  water  becomes 
softer.  After  allowing  to  cool  and  filtering,  the  perma- 
nent hardness  is  determined  in  the  same  way  as  the  total 
hardness,  and  the  difference  between  these  two,  as  already 
stated,  is  the  removable  hardness. 

According  to  Wanklyn's  method,  the  degrees  of  hard- 
ness represent  "  the  potential  carbonate  of  lime,"  and  in 
translating  them  into  Clark's  degrees,  it  is  necessary  to 
deduct  1.  Thus,  in  the  above  example,  the  degrees  of 
hardness,  according  to  Clark's  standard,  would  be  16°. 

Altogether,  the  importance  of  this  test  has  been 
greatly  over-estimated,  and  it  is  seldom  that  the  medical 
officer  of  health  will  deem  it  necessary  to  employ  it. 

(3.)  Chlorides. — The  estimation  of  chlorine  as  chlorides 
in  water  can  be  readily  determined  volunietrically  by 
means  of  chromate  of  potash  and  a  standard  solution  of 
nitrate  of  silver.  This  solution  is  prepared  by  dissolving 
4*  7  9  grammes  of  dry  nitrate  of  silver  in  a  litre  of  distilled 
water.  As  chromate  of  silver  is  soluble  in  acids,  it  is 
necessary  that  the  nitrate  of  silver  used  should  be  neutral. 
Each  c.  c.  of  this  solution  precipitates  1  milligramme  of 
chlorine.  70  c.  c.  of  the  water  to  be  examined  are  put 
into  a  beaker  or  evaporating  dish,  and  a  small  crystal 


WATER  ANALYSIS.  185 

of  pure  chromate  of  potash,  or  a  few  drops  of  a  strong 
solution  of  this  salt  added,  sufficient  in  either  case  to 
produce  a  distinct  yellow  tint.  The  standard  solution  is 
then  dropped  carefully  in  from  a  graduated  pipette  or 
burette,  and  directly  the  first  faint  tinge  of  red  is  discern- 
ible and  remains  permanent  on  stirring,  the  whole  of  the 
chlorine  is  precipitated,  and  chromate  of  silver,  which  is 
a  dark  red,  is  formed.  The  number  of  c.  c.  of  the  solu- 
tion used  before  this  red  tinge  is  obtained  represents  the 
number  of  grains  of  chlorine  per  gallon  of  water.  If,  for 
example,  3*5  c.  c.  of  the  solution  have  been  required,  the 
water  contains  3*5  grains  of  chlorine  per  gallon. 

The  following  are  examples  of  the  amount  of  chlorine 
in  different  waters  : — 

GTS.  per  Gallon. 

Thames  at  Kew -847 

Thames  at  London  Bridge    .         .         .  4 '452 

Bala  Lake -  706 

Polluted  well  at  Rugby         .         .         .  7  '5 

The  indications  afforded  by  the  chlorine  test  have 
previously  been  dwelt  upon  in  the  remarks  on  the  quali- 
tative examination  of  water,  and  they  need  not  therefore 
be  further  referred  to  here. 

(4.)  Ammonia  and  Organic  Matter. — Of  the  two  rival 
methods  of  estimating  the  organic  matter  in  water  — 
namely,  that  of  Frankland  and  Armstrong,  and  that  de- 
vised by  Wanklyn,  Chapman,  and  Smith — there  is  a 
general  concurrence  of  opinion  that  the  latter  is  especially 
suited  for  the  medical  officer  of  health,  because  it  is  easy 
of  application,  and,  so  far  as  chemical  analysis  can  at 
present  indicate,  yields  sufficiently  accurate  results  for 
ordinary  hygienic  purposes.  Frankland's  process  of  esti- 
mating the  organic  carbon  and  nitrogen  is  a  method  of 
no  small  difficulty,  and  in  the  hands  of  any  but  an  ex- 
perienced chemist  the  risk  of  experimental  error  is  very 
considerable.  What  is  known  as  the  Auiinoni".  j/rocess, 


186  WATER  ANALYSIS. 

therefore,  will  be  the  process  described  here.  For  a  full 
description  of  this  process  the  reader  is  referred  to  Mr. 
Wanklyn's  excellent  text -book  on  water  analysis,  from 
which  the  following  remarks  are  for  the  most  part  collated. 
The  rationale  of  the  process  depends  upon  the  fact  that 
vague  and  indefinite  nitrogenous  bodies  can  be  converted 
into  a  definite  compound,  namely,  ammonia,  and  that  in 
this  way  they  can  be  estimated  and  expressed  as  ammonia. 
Owing  to  the  excessive  minuteness  of  the  quantities  of 
nitrogenous  compounds  which  distinguish  between  a  good 
and  a  bad. water,  it  is  convenient  to  adopt  a  much  finer 
scale  of  measurement  than  is  requisite  for  the  saline  con- 
stituents ;  and  the  amount  of  ammonia  is  accordingly 
expressed  by  milligrammes  per  litre,  or  so  many  parts  in 
a  million.  The  re-agents  which  are  employed  are  the 
Nessler  test,  a  standard  solution  of  ammonia,  a  saturated 
solution  of  carbonate  of  soda,  and  a  solution  of  potassium 
permanganate  and  caustic  potash. 

a.  Nessler  Test. — Dissolve,  by  heating,  35  grammes 
of  iodide  of  potassium  and  1 3  grammes  of  corrosive  subli- 
mate in  about  half  a  litre  of  distilled  water,  and  after- 
wards add  gradually  a  cold  saturated  solution  of  corrosive 
sublimate,  and  keep  stirring  until  the  red  colour  produced 
begins  to  be  permanent.  Then  add  160  grammes  of 
caustic  potash  dissolved  in  about  200,c.  c.  of  distilled 
water,  and  dilute  with  sufficient  water  to  bring  the  whole 
up  to  a  litre.  To  render  the  test  sensitive,  add  about  20 
more  c.  c.  of  the  saturated  solution  of  corrosive  sublimate, 
and  allow  it  to  stand  in  a  stoppered  bottle  until  the  pre- 
cipitate has  subsided.  The  clear  liquid  may  now  be 
decanted  and  kept  in  a  tightly  stoppered  stock  bottle 
ready  for  use. 

1.  Standard  Solution  of  Ammonia. — Dissolve  3*15 
grammes  of  crystallised  sal  ammoniac  or  ammonium 
chloride  in  one  litre  of  distilled  water.  Every  cubic 


WATER  ANALYSIS.  18*7 

centimetre  of  this  solution  contains  one  milligramme  of 
ammonia.  This  is  termed  the  strong  solution,  and  is  the 
most  convenient  to  keep.  To  prepare  the  dilute  solution, 
put  5  c.  c.  of  the  strong  solution  into  a  half -litre  flask, 
and  fill  up  with  distilled  water.  This  is  the  standard 
solution  of  ammonia,  and  contains  0*01  milligramme  of 
ammonia  in  one  cubic  centimetre  of  water. 

c.  The  Saturated  Solution  of  Carbonate  of  Soda  may 
be  prepared  by  boiling  an  excess  of  the  common  carbonate 
in  distilled  water.     About  1 0  c.  c.  of  this  solution  is  the 
proper  quantity  to  use,  or  instead  of  the  solution  about 
one  gramme  of  the  dry  carbonate  of  soda,  which  has  just 
been  ignited,  may  be  employed.     The  carbonate  of  soda  is 
used  in  order  that  the  free  ammonia  may  be  more  easily 
dispelled  on  distillation. 

d.  The  Permanganate  of  Potash  and  Oaustic  Potash 
Solution  is  prepared  as  follows  : — Dissolve  8  grammes  of 
crystallised  permanganate  of  potash,  and  200  grammes  of 
solid  caustic  potash  in  one  litre  of  distilled  water.     Boil 
the  solution  for  some  time  to  free  it  from  all  traces  of 
ammonia,  and  afterwards  replace  the  water  lost  by  eva- 
poration by  adding  sufficient  distilled  water  to  make  up 
the  litre. 

The  distilled  water  which  is  used  to  make  up  the 
various  solutions  may  be  obtained  of  sufficient  purity 
from  any  common  drinking  water,  if  care  is  taken  to  re- 
ject the  first  portions  of  distillate,  and  the  distillation  is 
not  pushed  too  far.  It  should  always  be  carefully  tested 
before  being  used,  and  so  chemically  pure  that  in  100  c. 
c.  there  ought  not  to  be  0*005  milligramme  of  ammonia. 

The  following  is  a  list  of  the  apparatus  required  for 
the  process  (see  also  Appendix) : — A  stoppered  retort, 
capable  of  holding  at  least  one  litre;  a  Liebig's  condenser; 
a  good-sized  Bunsen's  lamp  or  burner ;  a  retort-holder  ; 
about  half  a  dozen  Nessler  glasses  made  of  white  glass, 


188  WATER  ANALYSIS. 

and  with  a  mark  at  5  0  c.  c. ;  a  half-litre  flask  ;  a  gradu- 
ated burette  marked  into  c.  c.,  to  measure  off  the  standard 
solution  of  ammonia ;  and  a  pipette  marked  to  hold  2 
c.  c.  It  need  hardly  be  said  that  the  greatest  care  must 
be  taken  to  have  the  whole  of  the  apparatus  thoroughly 
clean  before  it  is  used.  Glass  vessels  should  first  be 
washed  out  with  a  little  strong  hydrochloric  or  sulphuric 
acid,  and  afterwards  with  pure  water. 

The  analysis  itself  is  thus  performed  : — After  mount- 
ing the  retort  on  the  holder,  and  properly  connecting  it 
with  the  Liebig's  condenser,  half  a  litre  of  the  water  to 
be  examined  is  poured  into  it,  and  10  c.  c.  of  the  solution 
of  carbonate  of  soda  added.  The  Bunsen  lamp  is  now 
lighted,  the  retort  thrust  well  down  into  the  flame,  and 
50  c.  c.  are  distilled  over  into  a  Nessler  glass,  and  Ness- 
lerised.  Then  distil  over  150  c.  c.  and  throw  this  distil- 
late away.  This  amount  is  thrown  away  because  it  has 
been  found  that  the  first  distillate  contains  exactly  three- 
fourths  of  the  free  ammonia  present  in  the  water,  and  it 
is  therefore  a  waste  of  labour  to  Nesslerise  the  whole  of 
the  four  50  c.  c.  distilled  over.  There  are  now  300  c.  c. 
left  in  the  retort,  and  in  order  to  liberate  the  "albu- 
minoid ammonia,"  5  0  c.  c.  of  the  permanganate  of  potash 
and  caustic  potash  solution  are  poured  into  the  retort  by 
means  of  a  wide  funnel.  To  prevent  bumping,  which  is 
very  liable  to  occur  with  a  bad  water,  the  retort  should 
be  gently  shaken,  so  as  to  give  the  mixture  a  wavy  motion. 
The  distillation  is  then  continued,  and  three  separate  dis- 
tillates, each  of  50  c.  c.,  taken  and  Nesslerised. 

What  is  called  Nesslerising  is  the  process  of  ascer- 
taining the  strength  of  a  dilute  solution  of  ammonia  by 
means  of  the  Nessler  re -agent,  and  is  indeed  one  of 
the  most  beautiful  examples  of  colorimetric  analysis.  Let 
the  first  distillate  of  50  c.  c.  be  taken  as  an  illustration. 
To  this  distillate,  which  is  contained  in  one  of  the 


WATER  ANALYSIS.  189 

Nessler  glasses,  2  c.  c.  of  the  Nessler  re-agent  are  added 
by  means  of  the  2  c.  c.  pipette,  which  also  serves  as  a 
convenient  stirrer.  If,  after  stirring  and  waiting  about  a 
couple  of  minutes,  the  liquid  assumes  a  rich  deep  brown, 
it  contains  much  ammonia ;  if  even  a  distinct  brown  tint 
is  developed,  it  contains  a  considerable  quantity  of  am- 
monia ;  but  if  it  remain  colourless,  it  does  not  contain  so 
much  as  *005  milligramme.  When  only  a  light-yellowish 
tint  is  produced,  the  amount  of  ammonia  present  is  com- 
paratively small.  In  any  case,  however,  the  exact  amount 
is  determined  by  comparing  with  a  known  solution  of 
ammonia.  The  depth  of  tint  in  the  distillate  is  imitated 
by  mixing,  in  a  Nessler  glass,  more  or  less  of  the  dilute 
standard  of  ammonia  contained  in  the  burette  with  dis- 
tilled water,  and  filling  up  to  50  c.  c.,  and  then  adding  2 
c.  c.  of  the  Nessler  re-agent.  If,  after  stirring  and  waiting 
two  or  three  minutes,  the  tint  developed  in  the  artificially 
prepared  solution  is  too  dark  or  too  light,  it  is  necessary 
to  make  another  artificial  solution  of  less  or  greater 
strength,  as  the  case  may  be.  With  a  little  practice  it 
is  easy  to  approximate  very  closely  to  the  exact  amount 
of  the  standard  solution  of  ammonia  which  will  be  re- 
quired to  produce  a  tint  on  the  addition  of  2  c.  c.  of  the 
Nessler  re-agent,  which  will  harmonise  completely  with 
the  tint  of  the  distillate.  In  order  to  be  able  to  compare 
the  tints  accurately,  the  Nessler  glasses  should  be  placed 
on  a  white  porcelain  slab  or  sheet  of  white  paper.  The 
number  of  cubic  centimetres  of  the  standard  solution  of 
ammonia,  which  on  the  addition  of  the  Nessler  re-agent 
were  required  to  reproduce  the  exact  tint  given  by  the 
distillate,  are  noted,  and  the  amount  of  "  free  ammonia  " 
contained  in  the  sample  of  water  can  then  be  readily 
calculated. 

The  other  three  distillates  which  contain  the  albumi- 
noid ammonia  are  Nesslerised  in  the  same  way,  and  the 


190  WATER  ANALYSIS. 

amount  of  the  standard  solution  of  ammonia,  which  was 
required  to  imitate  the  tint  in  each  case,  is  also  noted. 
These  several  amounts  added  together  represent  the  total 
"  albuminoid  ammonia  "  contained  in  half  a  litre  of  the 
water.  It  has  already  been  pointed  out  that  the  first  50 
c.  c.  which  were  distilled  over  contain  three-fourths  of 
the  whole  of  the  "  free  ammonia,"  and  that  therefore  the 
next  150  c.  c.  distilled  over  may  be  thrown  away.  It 
was  formerly  the  practice  of  Mr.  "Wanklyn  to  Nesslerise 
the  whole  four  50  c.  c.  to  obtain  the  total  of  the  free 
ammonia,  but  the  amount  contained  in  the  first  distillate 
was  found  to  bear  such  a  constant  ratio  to  the  amount 
contained  in  the  other  three  distillates,  namely,  as  3  to  1, 
that  it  becomes  a  needless  expenditure  of  labour  to  Ness- 
lerise  them.  The  rule,  therefore,  is  to  add  one-third  to 
the  amount  of  ammonia  found  in  the  first  distillate,  in 
order  to  obtain  the  whole  of  the  free  ammonia. 

Eemembering  now  that  each  cubic  centimetre  of  the 
standard  solution  contains  '01  milligramme  of  ammonia, 
the  calculation  in  any  given  case  becomes  very  simple. 
For  example,  suppose  the  amount  of  dilute  standard  solu- 
tion of  ammonia  required  to  match  the  tint  in  each  case 
to  be  as  follows  : — 

Free  ammonia  distillate   .         .         .  .         .  2  c.  c. 

( 1st  distillate  ...  5    „ 

Albuminoid  ammonia-!  2d         „  .         .  2*5  ,, 

•       Ud         „  .         .  -5  „ 

then  we  arrive  at  the  following  amounts  : — 

Milligrammes. 
Free  ammonia  =  '02  +  -^  =  '027 

o 

C  1st  distillate       ...         '05 

Albuminoid  ammonia -I  2d         ,,  ...         '025 

(,3d         ,,  ...         -005 

Total  albuminoid  ammonia        .         .         '08 

But,  inasmuch  as   half  a   litre  of  water   was  taken  for 


WATER  ANALYSIS. 


191 


analysis,  these  results  must  be  multiplied  by  2  in  order 
to  arrive  at  the  amounts  per  litre,  or  per  million  parts. 
In  the  above  example,  therefore,  the  results  would  be 
stated  as  follows  : — 


Free  ammonia 
Albuminoid  ammonia 


Parts  in  a  million,  or 
milligrammes  per  litre. 
•054 
•16 


In  this  process  of  water  analysis  it  will  be  observed  from 
the  above  description  that  ammonia  is  to  be  looked  for  at 
two  stages :  firstly,  in  distilling  oft"  with  the  carbonate  of 
soda  solution ;  and  secondly,  on  distilling  off  with  the 
alkaline  permanganate  solution.  The  first  portion  of  the 
ammonia  is  called  the  "  free  ammonia,"  because  it  is  ob- 
tained from  the  decomposition  of  those  organic  impurities 
in  water  which  are  of  simple  constitution,  such  as"  the 
ureal  class,  as  well  as  the  ammonia  which  may  be  present 
as  ammonia.  The  second  portions  of  ammonia  are  named 
"  albuminoid  ammonia,"  because  the  ammonia  which  is 
given  off  is  derived  from  the  oxidation  of  those  more  com- 
plex nitrogenous  impurities  which  are  closely  allied  to 
albumen. 

The  following  are  examples  of  pure,  indifferent,  and 
bad  samples  of  water,  as  determined  by  the  ammonia 
process : — 


Free 

Albuminoid 

Ammonia, 
parts  per 
1,000,000. 

Ammonia, 
parts  per 
1,000,000. 

Quality. 

Name  of 
Authority. 

Loch  Katrine 

•004 

•08 

Good 

Wanklyn 

Water  from  Kent  Com- 

pany's mains 
Edinburgh  Water  Sup- 

•01 

•02 

» 

M 

ply,  Colinton,  1867    . 

•14 

•08 

Indifferent 

Great  St.  Helen's  pump, 

London 

375 

•18 

Bad 

>  » 

With  regard  to  the  inferences  which  may  be  deduced 


192  WATER  ANALYSIS. 

concerning  the  quality  of  a  water  as  indicated  by  this 
method  of  examination,  Mr.  Wanklyn  has  laid  down  the 
following  rules  in  the  third  edition  of  his  work  on  water 
analysis: — "If  a  water  yield  '00  parts  of  albuminoid 
ammonia  per  million,  it  may  be  passed  as  organically 
pure,  despite  of  much  free  ammonia  and  chlorides ;  and 
if,  indeed,  the  albuminoid  ammonia  amount  to  '02,  or  to 
less  than  '05  parts  per  million,  the  water  belongs  to  the 
class  of  very  pure  water.  When  the  albuminoid  ammonia 
amounts  to  '05,  then  the  proportion  of  free  ammonia 
becomes  an  element  in  the  calculation ;  and  I  should  be 
inclined  to  regard  with  some  suspicion  a  water  yielding 
a  considerable  quantity  of  free  ammonia,  along  with  '05 
parts  of  albuminoid  ammonia  per  million.  Free  ammonia, 
however,  being  absent  or  very  small,  a  water  should  not 
be  condemned  unless  the  albuminoid  ammonia  reaches 
something  like  "10  per  million.  Albuminoid  ammonia 
above  *10  per  million  begins  to  be  a  very  suspicious  sign  ; 
and  over  '15  ought  to  condemn  a  water  absolutely." 

But  the  recent  experiments  of  Dr.  Cory,  to  which 
reference  is  made  at  the  close  of  this  chapter,  prove  clearly 
that  polluting  matter,  potent  for  harm,  may  be  present 
in  water  which,  according  to  Wanklyn's  analysis,  may  be 
passed  as  organically  pure,  and  hence  it  is  of  the  utmost 
importance  that  the  surroundings  and  possible  sources 
of  pollution  of  a  particular  supply  should  always  be 
carefully  taken  into  consideration.  No  matter  what  pro- 
cess may  be  adopted,  whether  Wanklyn's,  Frankland's, 
Dupre's,  or  Tidy's,  water  analysis  can  only  indicate  de- 
grees of  impurity  and  danger,  not  standards  of  purity 
and  safety. 

On  the  other  hand,  it  must  be  admitted  that  there  are 
many  surface  well-waters  in  country  districts  containing 
even  more  than  "15  parts  per  million  of  albuminoid  am- 
monia, and  to  which  no  bad  effects  can  be  traced,  but  in 


WATER  ANALYSIS.  193 

these  cases  it  is  probable  that  the  ammonia  is  chiefly 
derived  from  vegetable  matter.  If  the  quantity  of  chlorine 
found  in  a  water  is  exceedingly  small,  any  excess  of  albu- 
minoid ammonia  would  indicate  that  the  nitrogenous 
matter  present  is  of  vegetable  and  not  of  animal  origin, 
and  therefore  comparatively  innocuous.  At  the  same 
time  it  should  be  remembered  that  there  might  be  the 
same  absence  of  chlorine  if  the  water  becomes  polluted 
from  the  presence  of  the  body  of  a  dead  animal  in  a  well 
or  cistern. 

In  conducting  a  water  analysis,  it  is  expedient,  if  the 
amount  of  solids  is  to  be  taken,  to  commence  the  evapora- 
tion for  the  solids  first, 'then  to  commence  distilling  for 
the  ammonia,  and  while  the  evaporation  and  distillation 
are  going  on,  to  determine  the  amount  of  chlorides,  and 
the  degree  of  hardness,  if  that  be  considered  necessary. 
It  is  always  advisable  to  keep  a  detailed  record  of  the 
results  of  every  analysis  in  a  book  set  apart  for  that 
purpose.  The  form  of  report  or  certificate  will  of  course 
vary  according  to  the  number  of  data  and  the  mode  of 
analysis,  but  the  following  hints  will  indicate  generally 
how  it  should  be  drawn  up : — 

Date  of  reception  of  sample,  size  and  description  of  bottle  or 
bottles,  how  stoppered  or  sealed,  and  how  labelled. 

Physical  Examination. 

Appearance         .         (Clear,  or  slightly  turbid,  etc.) 
Taste          .          .          (Tasteless,  or  unpleasant,  etc.) 
Odour        .          .          (Odourless,  foetid,  etc.) 
Deposit      .          .          (Slight  or  large,  dirty-looking,  flocculent, 
etc.) 

Microscopic  Examination. 

(Sandy  particles,  vegetable  matters,  animal  matters,  vibriones, 
etc.) 


194  WATER  ANALYSIS. 

Chemical  Examination. 

Qualitative  results : — 

Free  Ammonia       .  (None — traces— large  amount.) 

Nitrites         .          .  (None — traces — large  amount.) 

Nitrates         .          .  (None — slight  traces,  etc.) 

Sulphates      .          .  (None — slight  traces,  etc.) 

Metals  .          .  (None — traces  of  lead,  etc.) 

Quantitative  results  : — 

Total  solids  .         (In  grs.  per  gallon.) 

Chlorides      .          .          (In  grs.  per  gallon.) 
Hardness,  total     .          (In  degrees.) 
„          permanent     (In  degrees.) 
Free  ammonia      .          (Parts  per  million.) 
Albuminoid  ammonia    (Parts  per  million.) 
Remarks  as  to  whether  the  water  is  soft  or  hard,  of  good  quality 
and  fit  for  use,  or  whether  it  is  polluted  and  unfit  for  use. 
Date  of  analysis, — signature,  etc. 

As  it  is  becoming  customary  to  express  the  results  of 
the  ammonia  process  in  grains  per  gallon  instead  of  parts 
per  million,  the  following  formula  will  indicate  the 
method  of  calculation  : — 

100  :  7   : :  '15  (parts  per  million)  :  '0105  (grains  per  gallon). 

Exclusive  of  the  microscopic  examination,  which  is 
seldom  undertaken  or  required,  a  water  analysis  giving 
the  above  data  may  be  completed  in  about  an  hour, 
provided,  of  course,  that  the  operator  is  fairly  expert  at 
his  work  and  has  all  his  test  and  standard  solutions  pre- 
pared beforehand.  The  busy  medical  officer  of  health 
may  obtain  most  of  these  solutions,  as  well  as  distilled 
water,  from  chemists,  but  he  should  always  make  blank 
experiments  to  test  their  purity  and  quality. 

Although  I  have  thus  far  endeavoured  to  describe 
clearly  and  concisely  the  various  steps  of  an  ordinary 
water  analysis,  I  nevertheless  consider  it  very  essential 
that  every  one  who  has  to  undertake  this  kind  of  work 
should  receive  some  lessons  in  the  laboratory  of  a  com- 


WATER  ANALYSIS.  195 

petent  analyst.  If  he  is  precluded  from  doing  this,  he 
may  teach  himself,  provided  that  he  has  a  fair  knowledge 
of  elementary  and  practical  chemistry,  but  in  this  case  he 
ought  to  experiment  with  samples  obtained  from  a  public 
supply,  and  compare  his  results  with  those  of  recorded 
analyses  of  that  supply. 

As  already  stated,  any  proposed  new  public  supply 
should  be  submitted  to  a  full  quantitative  analysis  of  its 
saline  and  other  constituents,  and  for  this  purpose  samples 
should  be  sent  to  a  professed  analyst.  It  should  not  only 
be  usable,  but  the  best  which  can  be  procured  within  the 
limits  of  reasonable  expenditure.  All  waters  subjected 
to  filtration  should  be  examined  from  time  to  time,  to 
ascertain  that  the  filtering  process  is  carried  on  efficiently. 
Any  water  which  gives  indications  of  having  become  con- 
taminated with  animal  or  other  impurities,  and  which 
has  hitherto  been  good  and  wholesome,  should  be  entirely 
disused  until  the  source  of  contamination  has  been  dis- 
covered and  removed. 

A  list  of  tests,  etc.,  is  given  in  the  Appendix. 

Concluding  Remarks. — Although  it  must  be  admitted 
that  the  methods  of  water  analyses  which  are  now  in 
use  are  capable  of  detecting  very  minute  quantities  of 
organic  matter  in  large  volumes  of  water,  it  must  always 
be  borne  in  mind,  as  previously  pointed  out,  that  chemical 
analysis  however  complete  is  powerless  to  indicate  any 
standard  of  safety  when  a  water  becomes  specifically 
polluted.  The  careful  experiments  conducted  by  Drs. 
Cory  and  Dupre,  at  the  instigation  of  the  Local  Govern- 
ment Board,  and  published  in  the  last  report  of  the 
Medical  Officer  of  the  Board,  prove  clearly  that  chemistry 
cannot  tell  whether  a  healthy  or  a  diseased  body  has 
been  the  source  of  any  excremental  pollution  of  any 
particular  water.  Many  of  Dr.  Cory's  observations  had 
special  reference  to  experimental  contamination  of  differ- 


196  WATER  ANALYSIS. 

ent  waters, — some  with  healthy  stools  and  some  with 
the  stools  of  enteric  fever  patients,  and  the  results  not 
only  gave  no  indication  as  to  whether  the  polluting  matter 
came  from  a  healthy  or  diseased  body,  but  failed  to  in- 
dicate the  presence  of  an  amount  of  specifically  pollut- 
ing matter  which  must  have  been  far  in  excess  of  that 
which  proved  so  disastrous  in  the  well-known  Caterham 
epidemic  (see  following  chapter).  The  lessons  which 
may  be  learned  from  this  inquiry  are  so  ably  summed  up 
by  Dr.  Buchanan  that  I  cannot  do  better  than  quote 
them  here  : — "  While  we  must  ever  be  on  the  watch  for 
the  indications  that  chemistry  affords  of  contaminating 
matters  gaining  access  to  our  waters,  we  must  (at  any 
rate  until  other  methods  of  recognition  are  discovered) 
go  beyond  the  laboratory  for  evidence  of  any  drink- 
ing water  being  free  from  dangerous  organic  pollution. 
Unless  the  chemist  is  well  acquainted  w  ith  the  origin 
and  liabilities  of  the  water  he  is  examining,  he  is  not 
justified  in  speaking  of  a  water  as  '  safe '  or  '  wholesome/ 
if  it  contain  any  trace  whatever  of  organic  matter ; 
hardly,  indeed,  even  if  it  contain  absolutely  none  of  such 
matter  appreciable  by  his  very  delicate  methods.  The 
chemist,  in  brief,  can  tell  us  of  impurity  and  hazard, 
but  not  of  purity  and  safety.  For  information  about 
these  we  must  go,  with  the  aid  of  what  the  chemist 
has  been  able  to  teach  us,  in  search  of  the  conditions  sur- 
rounding water  sources  and  affecting  water  services." 
(Annual  Report  of  the,  Medical  Officer  of  the  Local  Govern- 
ment Board,  1881-1882.) 

Very  important  investigations  have  also  recently  been 
carried  out  in  America  under  the  direction  of  Professor 
.  W.  Millet,  of  the  University  of  Virginia,  for  the  National 
Board  of  Health,  which  are  strongly  corroborative  of  Dr. 
Cory's  results  and  deductions ;  and  when,  in  addition  to 
these,  we  take  into  consideration  the  importance  and  signi- 


WATER  ANALYSIS.  197 

ficance  of  the  researches  of  Dr.  Angus  Smith  in  applying 

1 1  Koch's^gelatine  process  to  the  detection  of  minute  organ- 

'  isms  in   samples  of  water  (see  Sanitary  Record,  1883), 

there  can  be  no  longer  question  that  present  methods  are 

in  many  respects  fallacious,  and  that  a  complete  reform 

in   water  testing  is   absolutely  required   before  samples 

submitted  for  analysis  can  be  pronounced  safe. 


198  IMPURE  WATER, 


CHAPTEE    VIII. 

IMPURE  WATER,  AND  ITS  EFFECTS  ON  PUBLIC  HEALTH. 

ALTHOUGH  impure  water  has  long  been  recognised  as  one 
of  the  most  potent  causes  of  disease,  it  is  only  of  recent 
years  that  minute  investigation  has  succeeded  in  demon- 
strating the  terrible  mortality  which  it  inflicts  on  all 
classes  of  the  community.  It  is  true  that  chemical 
analysis  often  fails  in  detecting  the  special  impurities 
on  which  the  development  of  certain  diseases  depends ; 
it  is  also  true  that,  even  when  impurities  are  detected,  it 
is  extremely  difficult  to  estimate  their  exact  etiological 
value ;  nevertheless,  the  broad  fact  remains,  and  it  is 
founded  on  evidence  of  the  most  conclusive  kind,  that  a 
vast  number  of  cases  of  disease  are  attributable  to.  the 
use  of  impure  water,  and  there  are  good  grounds  for 
believing  that,  as  investigations  become  more  frequent 
and  precise,  a  continually  increasing  class  of  such  cases 
will  be  discovered.  It  must  also  be  remembered  that  the 
effects  of  impure  water,  like  the  effects  of  impure  air, 
may  engender  a  general  impairment  of  the  health,  with- 
out giving  rise  to  well-pronounced  disease. 

Water  impurities  and  their  effects  may  be  conveni- 
ently considered  as  follows  : — Firstly,  water  rendered 
impure  by  an  excess  of  mineral  substances ;  secondly, 
water  rendered  impure  by  the  presence  of  vegetable 
matter;  thirdly,  water  rendered  impure  by  animal  or- 
ganic matter. 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  199 


SECTION  I. — WATER  RENDERED  IMPURE  BY  AN  EXCESS  OF 
MINERAL  SUBSTANCES. 

As  all  potable  waters  contain  a  certain  amount  of 
mineral  matters,  it  is   extremely  difficult  to  decide  the 
quantities  of   these  ingredients   which  may  be  present, 
either  singly  or  collectively,  without  producing  bad  effects. 
This   much,   however,   may   be    said,  that   waters   of    a 
moderate  amount  of  hardness,  provided  that  the  hardness 
depends  chiefly  on  the  presence  of  calcium  carbonate,  are 
not  found  to  be  detrimental  to  health.     A  water  of  8  or 
1 0  degrees  of  temporary  hardness,  equivalent  to  about  as 
many  grains  per  gallon  of  total  mineral  solids,  may  be 
pronounced  good  and  wholesome,  while  one  of  as  many 
degrees  of  permanent  hardness  would  prove  injurious  to 
many  persons.     With   regard  to  the  wholesomeness   of 
Thames   water,   with   a  hardness   averaging   15   degrees 
before  boiling  and   5   degrees  after,  the  evidence  given 
before  the  Eoyal  Commission  on  Water  Supply,  1869,  is 
somewhat  conflicting ;  for  while  Dr.  Letheby  considered 
a  moderately  hard  water,  such  as  the  Thames  water,  best 
suited  for  drinking  purposes  and  the  supply  of  cities,  Dr. 
Parkes  maintained  that  the  amount  of  hardness  should 
not  exceed  10  or  1 2  degrees,  if  possible.     Mr.  Simon  and 
Dr.  Lyon  Playfair,  on  the  other  hand,  although  they  did 
not  condemn  the  London  water  on  account  of  its  hard- 
ness, both  expressed  themselves   in  favour  of   a  softer 
water  for  purposes  of  health.     The  inference  that  may   , 
be  drawn  from  this  and  other  evidence  would  therefore  jl 
appear  to  be  this,  that  the  total  hardness  of  a  good  water 
ought  not  to  exceed  15  degrees,  nor  the  permanent  hard- 
ness 5  ;  or,  in  other  words,  that  even  in  a  moderately  hard 
wate~r7  calcium  carbonate  must  always  greatly  exceed  the 
magnesium  and  calcium  sulphates  and  sodium  chloride. 


200  IMPURE  WATER, 

The  symptoms  referable  to  an  excess  of  hardness, 
arising  from  the  presence  of  earthy  salts,  are  mainly  of 
a  dyspeptic  nature.  According  to  Dr.  Sutherland,  the 
use  of  the  hard  waters  derived  from  the  red  sandstone 
rocks  underlying  Liverpool,  produced  in  many  cases  con- 
stipation and  visceral  obstruction,  and  an  excess  of  calcium 
and  magnesium  sulphates  (7  to  10  grains  per  gallon)  has 
been  known  to  produce  diarrhoea. 

The  special  disease,  however,  which,  more  than  any 
other,  seems  intimately  connected  with  the  mineral  in- 
gredients of  water,  is  goitre.  In  some  parts  of  England, 
such  as  Yorkshire,  Derbyshire,  Hampshire,  and  Sussex, 
it  is  found  to  prevail  only  in  those  districts  where  the 
magnesian  limestone  formation  abounds.  According  to 
Dr.  Coindet  of  Geneva,  the  disease  is  speedily  produced  in 
persons  drinking  the  hard  pump  water  in  the  lower  streets 
of  that  town,  while  in  other  parts  of  Switzerland  the  use 
of  spring  water  has  been  followed  by  the  production  or 
augmentation  of  the  disease  in  a  few  days.  In  India, 
again,  the  researches,  more  especially  of  Dr.  M'Clellan, 
show  very  conclusively  that  it  is  found  to  prevail  only 
where  the  magnesian  limestone  formation  prevails. 
Whether  lime  and  magnesian  salts,  or  ferrum  sulphide, 
as  has  been  suggested  by  M.  Saint-Lager,  be  the  active 
agents  in  producing  the  disease,  has  not  yet  been 
rendered  quite  clear;  but  it  appears  certain  that  goitre 
is  originated  by  water-impurities,  and  that  these  are  of 
an  inorganic  and  not  organic  nature. — (Parkes.) 

The  latest  authorities  on  the  subject  believe  the 
impurity  to  be  of  a  metallic  nature,  probably  some  salt 
of  iron,  and  explain  the  prevalence  of  the  disease  in 
localities  where  the  magnesian  limestone  formation  pre- 
vails, by  maintaining  that  metalliferous  earths  are  always 
to  be  found  in  those  districts.  In  support  of  this  view 
it  must  be  admitted  that  in  many  limestone  localities 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  201 

the  disease  is  by  no  means  prevalent,  as  for  example,  in 
Scotland,  Ireland,  Norway,  and  Sweden,  where  mountain 
limestone  enters  largely  into  the  geological  formation. 
—  (Quain's  Dictionary  of  Medicine.) 

With  regard  to  this  subject,  Dr.  Brushfield,  formerly 
of  Brookwood,  Woking,  has  directed  my  attention  to  the 
prevalence  of  goitre  at  Pirbright,  a  village  near  Brook- 
wood,  especially  amongst  the  inhabitants  who  live  along 
the  course  of  a  certain  brook.  Even  the  clergyman's 
wife  contracted  the  disease  after  she  had  been  resident 
there  for  a  short  period.  But  instead  of  magnesian  lime- 
stone, the  geological  formation  throughout  the  district 
consists  of  Bagshot  sands  overlying  the  London  clay. 
Goitre  has  become  much  less  common  since  sanitary 
matters  have  been  better  attended  to. 

The  effects  of  minute  traces  of  metallic  compounds 
in  drinking  water  are  as  yet  comparatively  unknown.  It 
is  quite  possible  that  the  sanitary  condition  of  a  district 
may  in  some  measure  depend  on  impurities  of  this  de- 
scription, and,  as  Mr.  Wanklyn  suggests,  that  the  salutary 
effect  of  "  change  of  air  "  may  be  partly  due  to  change  in 
the  minute  metallic  impurity  in  the  water  of  the  parts  of 
the  country  which  are  visited. 

Of  the  metallic  ingredients,  the  effects  of  iron  and  lead 
have  been  the  most  fully  ascertained.  It  would  appear 
that  iron,  if  present  in  quantities  large  enough  to  impart 
a  chalybeate  taste  to  the  water,  often  produces  headache, 
slight  dyspepsia,  and  general  mal-aise,  while  impregnation 
with  lead  from  leaden  cisterns  or  pipes  has  frequently 
been  followed  by  symptoms  of  lead-poisoning.  In  the 
case  of  the  ex -royal  family  of  France,  many  of  whom 
suffered  when  at  Claremont  from  this  species  of  water 
contamination,  the  amount  did  not  exceed  one  grain  per 
gallon ;  indeed,  from  cases  which  have  since  occurred,  it 
seems  probable  that  the  habitual  use  of  water  containing 


202  IMPURE  WATER, 

from*  one- ten tli  to  one- twentieth  of  a  grain  per  gallon 
may  be  attended  with  danger.  In  his  investigations 
with  regard  to  the  Devonshire  colic,  which  formerly  pre- 
vailed to  a  great  extent,  Sir  George  Baker  found  that 
eighteen  bottles  of  cider  which  he  examined  contained 
4-J-  grains  of  lead,  or  a  quarter  of  a  grain  to  each  bottle. 
The  impregnation  arose  from  lead  being  employed  in  the 
construction  of  the  cider  troughs.  With  regard  to  the 
minor  effects  of  lead-poisoning,  there  are  good  grounds 
for  believing  that  many  obscure  forms  of  disease,  partak- 
ing more  particularly  of  the  nature  of  dyspepsia  and 
colic,  are  due  to  this  cause. 

Arsenic,  copper,  or  mercury,  are  only  found  in  the 
drinking  waters  of  this  country  in  injurious  quantities 
when  streams  are  polluted  by  the  washings  from  mines 
or  chemical  works. 


SECTION  II. — WATER  RENDERED  IMPURE  BY 
VEGETABLE  MATTER. 

Vegetable  matter  may  be  present  in  water  either  in 
suspension  or  in  solution.  In  peaty  water,  which  is 
characterised  by  its  brownish  tint,  the  dissolved  impurities 
sometimes  do  not  exceed  two  grains  per  gallon.  In  the 
absence  of  a  purer  supply,  a  water  of  this  description 
cannot  be  pronounced  objectionable,  provided  that  it  is 
not  stored  in  leaden  cisterns,  and  that  the  supply  is  con- 
stant. If  stored  in  open-air  ponds  or  reservoirs  it  is 
improved  by  oxidation  and  light ;  and  it  is  further  im- 
proved by  filtration  through  gravel  and  sand. 

Water  containing  a  considerable  amount  of  vegetable 
matter,  partly  in  suspension  and  partly  in  solution,  is 
decidedly  unwholesome.  It  has  been  known  to  produce 
violent  outbreaks  of  diarrhoea,  and,  since  the  days  of 
Hippocrates  downwards,  it  has  been  popularly  acknow- 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  203 

ledged  to  be  productive  of  ague  and  other  malarious 
ailments.  In  this  country  there  are  several  instances 
on  record,  that  ague  has  been  much  lessened  in  small 
communities  by  using  well  instead  of  surface  water ;  and 
there  is  strong  presumptive  evidence  that,  apart  from 
the  influences  attaching  to  improved  drainage,  the  great 
decline  of  this  disease  throughout  many  parts  of  England, 
where  it  formerly  prevailed,  is  in  some  measure  due  to 
the  use  of  purer  water. — (Parties.) 

SECTION  III. — WATER  RENDERED  IMPURE  BY  ANIMAL 
ORGANIC  MATTER. 

From  a  sanitary  point  of  view  this  is  by  far  the 
most  important  class  of  water  impurities.  The  presence 
of  putrescent  animal  matter,  whether  it  has  percolated 
through  the  soil  from  cesspools  or  other  filth-accumulations 
into  wells,  or  whether  it  has  been  discharged  from  open 
sewers  into  streams  and  rivers,  converts  drinking  water 
into  a  dangerous  poison,  fraught  with  disease  and  death. 
It  is  true  that  to  a  certain  extent  the  process  of  filtration 
through  a  porous  soil  tends  to  render  less  hurtful  the 
sewage  which  dribbles  into  a  well,  but  after  a  time  this 
purifying  power  is  lost,  thejsoil  ]becomes_.sodden,  and  the 
sewage  enters  unchanged.  It  is  also  true  that,  given  a 
sullicieiitly  large  stream,  a  sufficient  length  of  course,  and 
a  sufficient  length  of  time,  the  greater  portion  of  the 
sewage  discharged  into  a  river  will  become  converted  into 
harmless  products  by  oxidation.  Yet  neither  process  can 
be  trusted,  however  complete  it  may  appear  to  be.  There 
is  always  danger  lurking  in  a  water  which  is  known  to 
be  contaminated  with  animal  matter,  and  more  especially 
when  such  matter  is  partly  composed  of  the  evacuations 
of  patients  suffering  from  certain  specific  diseases,  such  as 
cholera  or  enteric  fever.  The  germs  of  disease,  which 


204  IMPURE  WATER, 

may  be  communicated  in  this  way,  have  a  tenacity  of  life  or 
chemico-physical  power  altogether  beyond  our  knowledge. 

Leaving  out  of  consideration  the  question  whether 
animal  organic  matter  in  suspension  or  in  solution  is  the 
more  injurious  to  health,  it  would  appear  that  it  is  the 
quality  rather  than  the  quantity  which  determines  the 
clanger.  As  already  stated,  a  trace  of  faecal  matter,  espe- 
cially when  undergoing  active  chemical  change,  may  render 
a  public  well  poisonous,  while  a  stream  of  sewer-gas  may 
contaminate  the  contents  of  a  cistern,  and  be  the  means 
of  prostrating  a  whole  household. 

The  principal  diseases  which  have  been  proved  to  be 
produced  by  this  class  of  water  impurities  are,  cholera, 
enteric  fever,  dysentery,  and  diarrhoea. 

1.  Cholera. — Although  much  had  been  previously 
written  with  regard  to  the  etiology  and  spread  of  cholera, 
it  was  not  generally  surmised  that  the  disease  could  "be 
propagated  by  a  polluted  water-supply  until  the  late  Dr. 
Snow  published  the  results  of  his  researches  in  1849. 
At  first  Dr.  Snow's  views  were  rejected  by  some,  or  ques- 
tioned by  others;  but  in  1854  there  occurred  a  violent 
outbreak  of  cholera  in  the  parish  of  St.  James,  West- 
minster, the  causes  of  which  were  inquired  into  by  a 
committee  of  medical  men,  whose  report  fully  substantiated 
Dr.  Snow's  conclusions.  Between  the  31st  August  and 
the  8th  September  of  that  year,  as  many  as  486  fatal 
cases  occurred  within  an  area  bounded  by  a  circle  whose 
radius  scarcely  exceeded  200  yards.  On  inquiring  into 
the  local  peculiarities  of  the  epidemic,  Dr.  Snow  found 
that,  the  sufferers  had  been  in  the  habit  of  drinking  the 
water  supplied  by  a  pump-well  in  Broad  Street,  which 
had  a  great  reputation  for  freshness  and  sweetness.  An 
analysis  of  the  water  proved  that  it  was  highly  charged 
with  animal  impurities,  and,  at  Dr.  Snow's  earnest  solicita- 
tion, the  handle  of  the  pump  was  removed  by  order  of  the 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  2Q5 

vestry  on  September  8th,  to  prevent  further  use  of  the 
water.  After  this  the  disease  gradually  subsided,  and 
ultimately  disappeared.  It  was  made  manifest,  by  a  // 
subsequent  examination,  that  the  sewage  of  a  neighbour- 
ing house  had  leaked  into  the  well,  and  it  was  further 
ascertained  that  the  evacuations  of  a  patient  residing  in 
the  house,  and  who  was  suffering  from  diarrhoea,  or  actual 
cholera,  must  have  mingled  with  the  sewage  immediately 
before  the  occurrence  of  the  general  outbreak.  No  evi- 
dence could  well  be  more  convincing  that,  in  this  instance 
at  least,  the  choleraic  poison  had  been  conveyed  by  the 
drinking  water. 

Amongst  other  remarkable  outbreaks,  which  go  to 
prove  that  this  mode  of  cholera  propagation  is  not  at  all 
uncommon,  may  be  mentioned  the  following : — In  the 
autumn  of  1865,  a  gentleman  and  his  wife,  from  the 
village  of  Theydon-Bois  in  Essex,  had  been  lodging  at 
Weymouth  for  two  or  three  weeks,  and  returned  home 
towards  the  end  of  September.  On  their  way  home  they 
passed  through  Dorchester,  where  the  gentleman  was 
seized  with  diarrhoea,  vomiting,  and  cramps,  which  con- 
tinued more  or  less  during  the  next  day  and  the  day 
following,  when  they  reached  Theydon-Bois.  During  the 
journey  the  wife  also  began  to  complain  of  abdominal 
pain,  which  was  followed  by  diarrhoea  and  eventually  by 
cholera,  from  which  she  died.  A  few  days  after  their 
return  the  disease  rapidly  attacked  other  members  of  the 
household,  so  that,  "  within  a  fortnight,  in  that  one  little 
circle,  eleven  persons  had  been  seized  with  cholera — 
mother,  father,  grandmother,  two  daughters,  son,  doctor, 
serving-lad,  servant-maid,  labourer,  and  country-woman ;. 
arid  of  these  eleven  only  three  survived — the  son,  a 
daughter,  and  the  serving -lad.  Later,  in  the  country- 
woman's family,  there  was  another  fatal  case.  It  cannot 
well  be  doubted,"  continues  Mr.  Simon,  "but  that  the 


206  IMPUKE  WATER, 

exciting  cause  of  this  succession  of  events  was,  in  some 
way  or  other,  the  return  of  the  parents  from  Weymouth ; 
of  the  father  with  the  remains  of  choleraic  diarrhoea  still 
on  him,  of  the  mother  with  apparently  the  beginnings  of 
the  same  complaint.  But  this  is  only  part  of  the  case, 
and  the  remainder  teaches  an  impressive  lesson.  All 
drinking  water  of  the  house  came  from  a  well  beneath  the 
floor  of  the.  scullery,  and  into  that  well  there  was  habitual 
soakage  from  the  water-closet." — (Eighth  Eeport  of  the 
Medical  Officer  of  the  Privy  Council.) 

In  addition  to  Mr.  Simon's  report  on  the  cholera 
epidemics  of  London  in  1848-49  and  1853-54,  in  which 
there  is  sufficient  evidence  to  show  that  the  pre valency  of 
the  disease  in  certain  districts  was  almost  entirely  deter- 
mined by  the  degree  of  impurity  of  the  water-supply,  the 
conclusions,  more  especially  of  Dr.  Parr  and  Mr.  Eadcliffe, 
with  regard  to  the  localisation  and  distribution  of  the 
epidemic  of  1866,  are,  if  possible,  more  confirmatory  still. 
Thus,  Dr.  Farr,  in  his  evidence  before  the  Eoyal  Commis- 
sion on  Water  Supply  in  1869,  stated -that  "in  all  the 
districts  supplied  by  the  Grand  Junction,  the  West 
Middlesex,  and  the  Chelsea  Waterworks  Companies,  the 
mortality  was  about  3  in  10,000  ;  in  those  supplied  by 
the  Southwark  and  Lambeth  Companies,  which  were  for- 
merly so  heavily  visited,  it  was  about  6  in  10,000  ;  and 
in  those  supplied  by  the  New  Kiver  Company,  about  8  in 
10,000  ;  while  in  those  supplied  by  the  East  London 
Company,  from  the  Old  Ford  Eeservoirs,  it  was  79  in 
10,000."  In  effect,  the  area  of  explosion  was  found  to 
be  limited  to  the  district  supplied  by  the  East  London 
Water  Company,  and  not  only  so,  but  Mr.  Kadcliffe's 
investigations  proved  that  the  water  delivered  from  the 
Old  Ford  covered  reservoirs  had  been  polluted  with  water 
from  the  filthy  uncovered  reservoirs,  and  that  these  latter 
had,  in  all  probability,  been  contaminated  with  soakage 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  207 

from  the  Eiver  Lea,  which  received  the  evacuations  of  the 
first  two  patients  who  died  of  epidemic  cholera  in  the 
eastern  districts. 

With  regard  to  Scotland,  the  evidence  of  Dr.  Steven- 
son Macadam,  as  to  the  influence  of  impure  water  on  the 
spread  of  cholera,  is  also  very  conclusive.  In  a  report 
read  before  the  members  of  the  British  Association  in 
1867,  he  showed  very  clearly  that  the  ravages  of  the 
disease  were  coincident  in  time  and  place  with  the  use  of 
water  from  impure  wells,  and  that  in  all  cases  the  abate- 
ment of  the  outbreak  followed  the  introduction  of  a  pure 
and  fresh  supply. 

Without  quoting  further  evidence,  it  is  sufficient  to 
state  that  the  weighty  authority  of  Dr.  Parkes  strongly 
confirms  this  view  of  choleraic  contagion ;  and  indeed  the 
opinions  of  Professor  von  Pettenkofer,  though  at  first 
sight  they  appear  to  be  antagonistic  to  the  theory,  do  in 
reality  support  it.  For,  while  he  considers  that  the  pro- 
pagation of  cholera  is  due  to  a  fermentation  of  the  rice- 
water  stools,  he  also  maintains  that  this  ferment  can  only 
act,  and  the  contagion  be  generated,  under  certain  local 
conditions — namely,  when  there  is  a  damp  porous  subsoil 
to  receive  the  ejecta.  Although  Pettenkofer  believes  that 
the  air  is  the  sole  channel  by  which  the  .cholera  miasm, 
thus  generated  in  the  soil,  is  spread,  there  is  no  doubt 
that  the  bearing  of  the  geological  influence  amounts  only 
to  this, — that  where  populations  are  living  on  a  damp 
open  subsoil,  with  no  artificial  water-supply,  nor  any  effi- 
cient system  of  drainage,  there  the  drinking  water,  as  well 
as  the  local  atmosphere,  is  almost  certain  to  be  largely 
polluted  by  those  frecal  impurities  amid  which  the  diar- 
rhceal  contagia  are  peculiarly  apt  to  multiply. — (Simon.) 

Whether  cholera  can  be  produced  by  animal  organic 
matters  not  of  a  specific  nature,  is  still  an  open  question. 
Very  probably  the  effect  of  constantly  drinking  a  certain 


208  IMPURE  WATER, 

amount  of  these  impurities  produces  a  lowered  state  of 
the  system  and  a  tendency  to  diarrhoea,  so  that,  when  the 
cholera  poison  is  abroad  in  the  atmosphere,  it  finds  its 
victims  in  largest  numbers  amongst  those  who  partake  of 
an  impure  water-supply.  This  much,  however,  appears 
certain,  that  whenever  cholera  evacuations  make  their 
way  into  the  drinking  water,  we  may  expect  to  find  the 
disease  burst  forth  with  the  greatest  virulence  and  fatality 
amongst  those  who  use  the  water,  and  that  indeed  the 
endemic  area  will  approximate  with  remarkable  closeness 
to  the  limits  of  the  district  which  it  supplies. 

2.  Enteric  or  Typhoid  Fever. — The  remarks  which 
have  just  been  made  with  regard  to  the  influence  which 
impure  water  exerts  on  the  spread  of  cholera,  apply  with 
still  greater  force  to  the  etiology  of  enteric  fever.  For, 
although  there  are  still  some  who  do  not  believe  in  the  com- 
municability  of  the  disease,  there  is  a  constantly  accumu- 
lating amount  of  evidence,  which  goes  to  prove  not  only 
that  the  poison  of  the  fever  may  be  conveyed  through  the 
agency  of  water  from  the  sick  to  the  healthy,  but  that  this 
is  the  most  common  mode  of  propagation.  Sir  W.  Jenner, 
than  whom  no  higher  authority  could  well  be  quoted,  in 
commenting  on  this  point,  says, — "  The  spread  of  typhoid 
fever  is,  if  possible,  less  disputable  than  the  spread  of 
cholera  by  the  same  means.  Solitary  cases,  outbreaks 
confined  to  single  houses,  to  small  villages,  and  to  parts 
of  large  towns — cases  isolated,  it  seems,  from  all  sources 
of  fallacy — and  epidemics  affecting  the  inhabitants  of 
large  though  limited  localities,  have  all  united  to  support 
by  their  testimony  the  truth  of  the  opinion  that  the  ad- 
mixture of  a  trace  of  feecal  matter,  but  especially  the  bowel 
excreta  of  typhoid  fever,  with  the  water  supplied  for  drink- 
ing purposes,  is  the  most  efficient  cause  of  the  spread  of 
the  disease,  and  that  the  diffusion  of  the  disease  in  any 
given  locality  is  limited,  or  otherwise,  and  just  in  proper- 


AXD  ITS  EFFECTS  OX  PUBLIC  HEALTH.  209 

tion  as  the  dwellers  of  that  locality  derive  their  supply  of 
drinking  water  from  polluted  sources." 

According  to  the  late  Dr.  William  Budd  it  also  appears 
to  be  highly  probable  that  when  the  poison  is  conveyed 
by  water,  infection  is  much  more  certain  than  when  it  is 
disseminated  by  the  air ;  and  in  support  of  this  statement 
he  instances  an  outbreak  which  occurred  in  Cowbridge  in 
Wales,  in  1853,  where,  out  of  some  90  or  100  persons 
who  went  to  a  ball,  fully  one  -  third  were  shortly  after- 
wards laid  up  with  fever.  Although  the  water  was  not 
examined,  there  was  satisfactory  reason  to  believe  that  it 
was  polluted. 

Since  that  date  numerous  other  local  outbreaks  have 
been  carefully  investigated,  and  some  with  so  much  pre- 
cision and  completeness  of  detail  that  they  are  noticed 
here  rather  as  examples  of  the  painstaking  and  systematic 
way  in  which  such  inquiries  should  be  conducted  than 
as  proving  this  mode  of  propagation  of  enteric  fever : — 

(1.)  In  the  spring  of  1867  Dr.  Thome,  one  of  the 
Health  Inspectors  of  the  Privy  Council,  was  ordered  to 
proceed  to  Winterton  in  Lincolnshire,  to  inquire  into  the 
causes  of  the  excessive  mortality  from  enteric  fever  which 
had  prevailed  more  or  less  during  the  previous  two  years 
in  different  parts  of  the  town,  but  had  latterly  assumed 
alarming  proportions.  The  small  town  numbered  about 
1800  inhabitants,  of  whom  about  nine-tenths  consisted  of 
the  labouring  classes,  living  for  the  most  part  in  well- 
built  cottages  and  earning  good  wages.  Absolute  poverty 
was  little  known  amongst  them,  intemperance  was  rare, 
and  only  in  two  instances  was  there  any  overcrowding. 
Moreover,  the  situation  of  the  town  was  healthy,  inasmuch 
u-j  it  was  built  on  a  gentle  slope  facilitating  drainage,  and 
the  subsoil  was  open  and  porous,  consisting  of  a  stratum 
of  oolitic  limestone  covered  by  a  light  marly  soil.  Yet, 
with  all  these  advantages,  the  number  of  deaths  in  1865 


210  IMPURE  WATER, 

amounted  to  51,  and  in  1866  to  44,  and  of  these  more 
than  a  third  had  died  of  enteric  fever.  At  the  date  of 
Dr.  Thome's  visit  55  cases  were  under  treatment,  and 
already  6  deaths  had  occurred  since  the  beginning  of  the 
year.  The  cause  of  all  this  sickness  and  mortality  is  best 
given  in  Dr.  Thome's  own  words : — 

"  The  epidemic  prevalence  of  fever  in  Winterton  is 
undoubtedly  to  be  ascribed  to  the  disgraceful  state  of  the 
privies,  cesspools,  ashpits,  c^nd  wells.  With  the  exception 
of  about  six  houses,  where  water-closets  have  been  con- 
structed, all  the  cottages  are  provided  with  privies,  which 
are  generally  built  of  brick,  and  have  an  aperture  at  the 
side  or  back,  through  which  they  can  be  cleaned  out. 
This  aperture  I  found  open  in  almost  all  instances,  and 
the  result  of  this  is  that  the  contents  of  at  least  half  the 
privies  in  the  town  run  out  into  the  gardens,  soak  into 
the  earth,  and  penetrate  in  many  instances  into  the  wells, 
besides  producing  the  most  offensive  odour.  In  addition 
to  this  many  of  the  tenants  either  throw  their  refuse  and 
slops,  including  urine,  into  the  yards  outside  their  doors, 
or  else  they  improvise  a  receptacle  by  digging  in  the 
ground  close  to  the  aperture  in  the  privy  wall.  The 
ftecal  matter  pours  into  it,  and  they  thus  add  to  their  pre- 
vious list  of  nuisances  that  of  an  open  cesspool.  In  some 
instances  ashpits  have  been  built,  but  these  are  uncovered, 
and  since  urine  and  the  bowel  discharges  of  the  typhoid 
patients  are  thrown  into  them,  in  addition  to  other  refuse, 
they  are  but  little  better  than  open  privies.  All  these 
sources  of  £ecal  fermentation  are  situated,  as  a  rule,  close 
to  the  houses,  and  in  some  instances  within  a  few  feet  of 
the  back  doors,  and  just  under  the  windows.  The  wells 
are  also  in  their  immediate  neighbourhood,  and  many  of 
the  inhabitants  informed  me  that  their  water  was  so  bad 
that  they  had  been  compelled  to  discontinue  drinking  it. 
In  one  instance  I  found  the  space  between  two  pigstyes 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  211 

entirely  occupied  by  a  well  3  feet  in  diameter.  Fever  is 
present  in  the  house  to  which  this  well  is  attached,  but 
since  the  occupants  do  not  use  it,  the  necessarily  conta- 
minated condition  of  the  water  cannot  be  considered  to 
bear  upon  the  disease.  Given  the  existence  of  typhoid 
fever  in  a  town,  it  is  hardly  possible  to  conceive  of  con- 
ditions more  favourable  for  its  spread  than  those  existing 
in  Winterton." — (Tenth  Eeport  of  the  Medical  Officer  of 
the  Privy  Council.) 

(2.)  In  the  autumn  of  the  same  year  (1867)  a  severe 
epidemic  of  enteric  fever  broke  out  in  Guildford.  Dr. 
Buchanan,  who  was  the  Government  Inspector  on  this 
occasion,  found  that  during  the  first  twenty-eight  days  of 
August,  10  cases  of  the  disease  had  occurred  in  different 
parts  of  the  town ;  when  suddenly,  within  the  next  thirty- 
three  days,  the  number  rose  to  about  250.  As  the 
epidemic  was  almost  exclusively  confined  to  a  part  of  the 
town  which  corresponded  with  a  particular  section  of  the 
public  water-supply,  suspicions  were  aroused  that  this  had 
become  polluted ;  and  on  further  investigation  it  was  as- 
certained that  on  a  particular  day,  about  ten  days  before 
the  outbreak,  the  houses  in  that  part  of  the  town  had  been 
exceptionally  supplied  with  water  from  a  certain  high- 
standing  reservoir  which  had  previously  been  filled  from  a 
new  well.  This  well  was  sunk  through  a  porous  stratum 
of  chalk,  and  in  close  proximity  to  it  were  various  sewers, 
one  of  which  was  afterwards  found  to  be  leaking  in 
several  places.  There  was  no  doubt,  therefore,  that  sewage 
had  oozed  through  the  chalk  into  the  well,  and  had  caused 
the  epidemic.  An  analysis  of  a  sample  of  the  water  was 
subsequently  made  by  the  late  Professor  Miller,  the 
results  of  which  gave  unmistakable  evidence  of  previous 
sewage  contamination.  —  (Tenth  Eeport  of  the  Medical 
Officer  of  the  Privy  Council.) 

(3.)  The  account  of  the  epidemic  at  Terling,  in  Essex, 


212  IMPURE  WATER, 

by  Dr.  Thorne,  is  especially  valuable  as  showing  the  effect 
of  a  sudden  rise  of  the  ground  water  level  in  a  village 
situated  on  a  porous  subsoil,  obtaining  its  water-supply 
from  shallow  wells,  and  allowing  its  excrementitious  filth 
to  accumulate  in  badly-constructed  privies  and  manure 
heaps,  or  to  lie  indiscriminately  in  scattered  masses  on 
the  surface  of  the  ground.  Out  of  a  population  of  900, 
about  one-third  of  the  number  were  attacked  with  enteric 
fever  within  a  period  of  two  months,  and  41  had  died. 
Some  ten  days  before  the  outbreak,  and  after  a  period  of 
prolonged  drought,  a  sudden  great  rise  in  the  water-level 
of  the  wells  was  observed  to  follow  a  heavy  fall  of  rain 
and  snow ;  in  other  words,  the  shallow  unprotected  wells 
sunk  in  the  porous  gravel  had  become  converted  into  so 
many  receptacles  for  the  washings  of  the  filth-sodden  soil, 
and  hence  the  epidemic.— (Tenth  Report  of  the  Medical 
Officer  of  the  Privy  Council.) 

(4.)  In  the  beginning  of  1873  a  severe  outbreak  of 
enteric  fever  occurred  in  the  small  town  of  Sherborne  in 
Dorset,  which  was  investigated  by  Dr.  Blaxall,  and  which 
is  of  extreme  interest  as  having  been  the  first  outbreak 
of  the  kind  which  was  clearly  traced  to  the  entrance  of 
sewer  air  into  the  water-mains.  Although  the  water- 
supply  was  intended  to  be  constant,  it  was  ascertained 
that  in  December  1872,  and  January  1873,  the  water 
was  frequently  shut  off  at  a  point  near  the  reservoir,  and 
that  during  the  month  of  February  it  was  shut  off  every 
night.  It  was  observed  that  when  the  water  was  turned 
off  there  were  certain  water-mains  up  which  there  was  a 
sudden  rush  of  air  immediately  the  tap  was  unscrewed, 
and  as  many  of  the  mains  communicated  directly  with 
closet-pans  by  means  of  taps,  which  were  sometimes  left 
open,  and  which  in  other  instances  were  broken,  there 
were  thus  numerous  inlets  for  the  entrance  of  air  from 
the  closet-pans  into  the  water-mains.  Moreover,  if  a  pan 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  213 

happened  to  become  full  of  excremental  filth,  there  was 
the  probability  of  excrement  as  well  as  sewer  air  having 
been  sucked  into  the  mains.  In  January  and  February 
there  were  about  27  cases  of  fever  in  the  town,  but  before 
the  end  of  April  the  number  altogether  had  increased  to 
240,  out  of  a  population  of  6041.  After  the  first  week, 
during  which  73  cases  occurred,  the  water-supply  was 
again  ma  le  constant,  and  the  epidemic  gradually  declined. 
— (Mr.  Simon's  Reports,  New  Series,  No.  II.) 

In  April  1882,  Dr.  Blaxall  was  commissioned  to  pay 
a  second  visit  to  Sherborne,  to  investigate  a  limited  out- 
break of  enteric  fever  which  was  confined  to  three  house- 
holds, and  it  is  very  noteworthy  that  the  fresh  outbreak 
afforded  a  second  illustration  of  similar  evils  appearing  to 
result  from  the  self-same  cause.  For  although  general 
disconnection  of  the  closets  from  water-mains  and  better 
ventilation  of  the  sewers  had  been  carried  out  in  con- 
sequence of  Dr.  Blaxall's  first  report,  it  was  very  signi- 
ficant that  such  disconnection  had  not  been  effected  in 
respect  to  the  closets  of  the  houses  to  which  the  second 
outbreak  was  limited  ;  indeed,  the  result  of  the  inquiry,  as 
in  the  first  outbreak,  confirmed  the  opinion  that  the 
drinking  of  water  contaminated  by  sewer  air  was  the 
channel  by  which  the  disease  was  spread.  Owing  to  the 
improvements  which  had  been  carried  out  there  had  been 
no  deaths  from  enteric  fever  from  1873  to  1882,  except 
during  one  year.  —  (Special  Eeport  to  Local  Government 
Board.) 

(5.)  Somewhat  akin  to  this  outbreak  in  its  mode  of  \  / 
causation  was  the  outbreak  of  enteric  fever  which  occurred 
at  Caius  College,  Cambridge,  towards  the  close  of  1873. 
Dr.  Buchanan's  report  on  this  outbreak  is  such  a  model 
of  painstaking  research  and  sound  reasoning,  that,  apart 
altogether  from  its  intrinsic  value  as  a  contribution  to  the 
etiology  of  fever,  it  ought  to  be  read  by  every  medical 


214  IMPURE  WATER, 

inquirer  as  one  of  the  most  lucid  expositions  in  the 
domains  of  medical  logic.  Without  detailing  at  any 
length  the  various  interesting  phases  of  the  inquiry,  it 
will  be  sufficient  here  to  state  that  the  cases  of  fever 
numbered  15,  that  the  incidence  of  these  cases  was  wholly 
upon  the  112  students  who  were  resident  in  the  college, 
and  that  12  out  of  the  15  cases  were  confined  to  63 
students,  residing  in  a  particular  part  of  the  college, 
namely  Tree  Court.  The  buildings  connected  with  this 
particular  court  had  been  erected  only  four  years  pre- 
viously, and  such  an  amount  of  care  had  been  expended 
on  the  sanitary  arrangements  that  any  injury  to  health 
arising  from  drains,  sewers,  or  water-pipes,  seemed  well- 
nigh  impossible.  Nevertheless,  the  chances  as  a  matter 
of  a  priori  probability  were  as  24  to  1  that  the  cause  of 
fever  depended  upon  some  condition  peculiar  to  Tree 
Court,  and  not  operative,  or  only  operative  to  a  very 
limited  extent,  in  other  parts  of  the  college.  After  con- 
sidering all  the  more  usual  ways  in  which  enteric  fever  is 
known  to  be  spread,  and  finding  that  none  of  them  could 
account  for  the  intensity  of  the  incidence  of  the  outbreak 
in  Tree  Court,  Dr.  Buchanan's  suspicions  were  directed  to 
the  water-supply.  Now,  the  water-supply  of  the  college 
was  taken  from  a  surrounding  5 -inch  main  at  six  different 
places,  and  at  one  of  them,  namely  at  the  Gate  of 
Humility,  there  was  a  branch  main  which  supplied  Tree 
Court  and  no  other  part  of  the  college.  In  short,  the 
area  of  this  particular  water  distribution  was  the  area  of 
the  fever,  and  although  there  was  no  doubt  that  the 
quality  of  the  public  water-supply  was  good,  this  was  no 
argument  against  a  "  local  contamination  in  a  local  ser- 
vice." It  had  struck  Dr.  Buchanan  at  an  early  stage  of 
the  inquiry  that  the  closets  in  Tree  Court  were  the  only 
closets  in  the  college  which  were  not  provided  with 
cisterns,  but  were  supplied  with  water  direct  from  the 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  215 

high-pressure  constant  main ;  and  on  further  inquiry  the 
following  facts  were  ascertained  : — (1)  That,  according  to 
the  servants,  there  was  occasional  intermission  in  the 
constant  service  of  water-supply ;  (2)  that  there  had  been 
two  actual  intermissions  during  the  term,  one  of  which 
occurred  about  October  25th,  or  a  fortnight  before  the 
first  case,  and  the  other  certainly  on  November  1st,  a 
fortnight  before  the  date  of  the  second,  third,  and  fourth 
attacks ;  and  (3)  that  although  the  mains  were  supplied 
with  valve-taps  which  were  believed  to  prevent  any  re- 
gurgitation  of  air  or  water,  it  was  clearly  proved  by 
experiment  that  there  was  a  reflux  of  air  and  water  into 
the  main  when  the  water  was  turned  off,  and  that  the 
valve-tap  was  useless  in  this  particular  instance  for  the 
purpose  for  which  it  was  intended. 

Of  the  closets  in  Tree  Court,  two  were  found  to  be 
connected  directly  with  the  water-main  which  supplied 
drinking  water  for  the  whole  of  the  court,  and  it  is  on 
the  structural  arrangements  of  these  closets  that  the 
chief  interest  of  the  inquiry  depends.  One  was  situated 
in  the  basement  of  the  porter's  lodge,  the  other  in  the 
staircase,  at  an  elevation  of  about  30  feet  above  the 
surrounding  water-main,  and  about  5  or  6  feet  above  the 
level  of  the  former.  Both  closets  were  of  similar  con- 
struction, and  both  were  considered  to  have  assisted  in 
contaminating  the  water-supply,  but  from  its  higher  ele- 
vation there  was  greater  probability  that  the  closet  in  the 
staircase  played  a  much  more  direct  part  than  the  one  on 
the  basement.  This  closet  was  ascertained  to  be  of  the 
S-bend  pattern,  but,  in  addition  to  the  pipe  communicating 
directly  with  the  pan,  there  was  found  to  be  a  smaller 
branch  pipe  dipping  into  the  opening  of  a  second  S-bend, 
which  was  also  connected  with  the  soil-pipe,  and  which 
wns  intended  to  drain  the  "  safe  "  of  the  closet  in  case  of 
its  being  flooded.  There  were  thus  two  channels  through 


216  IMPURE  WATER, 

which  influx  of  air  could  take  place  when  the  water- 
supply  became  intermittent,  and  in  the  case  of  the  smaller 
branch  there  was  the  further  possibility  of  liquid  filth 
.  being  sucked  into  the  water-main  under  certain  conditions. 
At  all  events,  the  air  which  thus  entered  "  must  have 
been  essentially  sewer  air,"  and  in  this  case  the  danger  of 
such  air  forcing  its  way  through  traps  was  greatly  in- 
creased by  the  circumstance  that  the  sewer  in  the  neigh- 
bouring street  was  unventilated,  and  that  between  the 
sewer  and  the  closet  there  was  no  opening  or  trap  of  any 
kind  connected  with  the  excrement  pipe  or  drain.  It 
was  further  discovered  that  during  the  month  of  October 
this  sewer  received  the  discharges  of  patients  suffering 
from  enteric  fever  in  other  parts  of  the  town,  so  that 
there  was  the  probability  of  the  sewer  air  having  been  at 
the  time  specifically  contaminated.  Lastly,  and  this  is  a 
most  significant  feature  of  the  inquiry,  Dr.  Buchanan 
thought  it  desirable  that  the  smaller  branch  pipe  and 
part  of  the  other  pipe  should  be  submitted  to  chemical 
examination,  it  having  been  observed  that  the  end  of  the 
former  was  crusted  over  with  a  dirty-looking  layer,  and 
that  the  inside  of  both  was  lined  with  deposit.  The 
analysis  was  accordingly  made  by  Dr.  Dupre*  of  "West- 
minster Hospital,  who  certified  that  the  dirty -looking 
layer  consisted  of  "  a  very  large  proportion  of  nitrogenised 
organic  matter,  and  a  very  considerable  proportion  of 
phosphoric  acid,"  and  that  he  had  little  doubt  that  it  was 
derived  from  "  water  strongly  impregnated  with  faecal 
matter."  The  deposit  inside  the  pipes  was  of  a  similar 
character,  so  that,  as  Dr.  Buchanan  puts  it,  "  Dr.  Dupre's 
results  show,  first,  that  (as  circumstantial  evidence  ap- 
peared to-  indicate)  excremental  matter  actually  had 
entered  the  water-pipes  of  the  staircase  closet,  and 
secondly,  that  it  had  in  fact  (what  had  before  been  sug- 
gested as  a  possibility)  entered  the  water-pipes  as  a 


'AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  217 

liquid.  In  no  other  way  can  the  presence  of  phosphates 
in  those  pipes  be  accounted  for." — (Mr.  Simon's  Reports, 
New  Series,  No.  II.) 

(6.)  While  there  can  be  little  doubt  that  this  parti- 
cular mode  of  enteric  fever  propagation  is  much  more 
frequent  than  is  usually  suspected,  the  following  outbreak 
will  suffice  to  show  the  dangers  which  threaten  any  town 
where  closets  directly  connected  with  water-mains  are 
numerous,  and  where  the  water-supply  is  intermittent : — 
During  the  latter  half  of  the  year  1874  an  epidemic,  of 
enteric  fever  prevailed  in  the  town  of  Lewes,  of  such 
severity  that  out  of  a  population  of  about  11,000,  nearly 
500  cases  had  occurred,  and  as  many  as  104  of  these 
took  place  during  the  last  week  of  October.  Dr.  Thome, 
who  was  appointed  to  report  upon  this  outbreak,  dis- 
covered, after  minute  inquiry,  that  "it  was  due,  in  the 
first  instance,  to  pollution  of  the  town  water-supply  by 
water  drawn  from  the  Ouse,  which  receives  the  town  sew- 
age, but  mainly  spread  by  suction  of  polluting  matter  into 
the  water-pipes  of  an  intermittent  water  service."  So  soon 
as  it  became  clear  that  the  epidemic  was  not  only  favoured, 
but  practically  insured,  by  the  intermittent  water-supply, 
Dr.  Thorn e  urged  the  necessity  of  a  constant  service,  and 
when  this  was  obtained  the  epidemic  became  virtually 
arrested. — (Mr.  Simon's  Reports,  New  Series,  No.  IV.) 

Although  in  these  several  epidemics  there  was  no  direct 
evidence  to  show  that  the  outbreak  depended,  in  the  first 
instance,  on  the  presence  of  the  enteric  poison  in  the  sewage 
which  contaminated  the  water,  it  is  nevertheless  note- 
worthy that  cases  of  the  fever  were  more  or  less  common 
in  the  several  localities  previous  to  the  outbreak.  The 
following  outbreaks,  however,  are  strongly  corroborative 
of  the  view  which  is  maintained  by  many  that  the 
disease  is  essentially  a  specific  disease,  and  can  only 
be  propagated  by  means  of  a  specific  contagium  : — 


218  IMPURE  WATER, 

(a.)  In  1872,  an  outbreak  occurred  at  Niamey,  a 
village  near  Frome,  and  Dr.  Ballard,  the  Local  Govern- 
ment Inspector,  who  was  sent  to  investigate  the  causes 
of  the  outbreak,  thus  states  the  conclusions  deducible 
from  his  inquiry :— "  1,  That  the  fever  at  Nuimey  was 
enteric ;  2,  that  it  was  brought  into  the  village  from  a 
distant  place  by  an  individual  whose  evacuations,  and 
those  also  of  others  attacked  in  the  same  and  in  the 
adjoining  house,  found  their  way  into  the  Nunney  brook, 
at  the  upper  part  of  the  village ;  3,  that  the  fever  spread 
in  the  village  in  consequence  of  the  villagers  habitually 
drinking  the  water  of  the  brook  thus  contaminated,  which 
water  was  still  further  polluted  with  the  sewage  of  the 
village  itself,  containing,  if  not  the  actual  excrement  of 
.the  sick,  yet  certainly  matters  washed  out  of  their  soiled 
linen,  and  also  more  or  less  of  their  liquid  evacuations ; 
4,  that  at  the  time  of  my  visit,  actual  excrement  from 
cases  of  enteric  fever  was  finding  its  way  into  the  brook 
at  a  hamlet  only  half  a  mile  above  the  village  of  Nunney." 
—(Med.  Times  and  Gazette,  1873.) 

(b.)  The  outbreak  at  Over  Darwen,  which  occurred 
towards  the  close  of  1874,  is  alike  remarkable  for  its 
terrible  severity  and  for  the  thoroughness  with  which  the 
cause  of  the  outbreak  was  traced  to  its  origin.  According 
to  Dr.  Stevens,  who  was  appointed  by  the  Local  Govern- 
ment Board  to  inquire  into  and  report  upon  the  epidemic, 
the  first  case  occurred  at  a  house  some  considerable  dis- 
tance from  the  town,  but  not  very  far  distant  from  the 
public  water-main.  The  patient,  having  contracted  the 
disease  elsewhere,  afterwards  came  home  ill,  and  died 
there.  On  first  inquiry  it  was  stated  that  the  water- 
supply  could  not  by  any  possibility  be  polluted  by  the 
excreta  from  this  case,  but  subsequent  investigations  ren- 
dered it  only  too  apparent  that  here  lay  the  whole  cause 
of  the  epidemic.  It  was  discovered  that  the  drain  of  the 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  219 

closet  into  which  the  excreta  of  this  patient  were  thrown 
crossed  the  line  of  the  water-main,  and  though  special 
precautions  had  been  taken  by  way  of  cementing  and  the 
like  to  prevent  any  leakage,  it  was  found  that  the  drain 
had  become  choked  up,  that  the  cement  had  given  way, 
and  that  the  contents  of  the  drain  were  sucked  freely, 
indeed  regularly,  into  the  water-main.  No  doubt  the 
general  filthy  condition  of  the  town  greatly  aided  in  pro- 
pagating the  epidemic  after  the  specific  contagium  had 
been  distributed  by  means  of  the  water-supply,  but  the 
terrible  rapidity  with  which  the  disease  spread  pointed 
clearly  to  specifically  polluted  water  as  being  the  prime 
cause  of  the  epidemic.  Out  of  a  population  of  about 
22,000,  2035  people  were  attacked  within  a  very  short 
period,  and  of  these  104  died. — (Sanitary  Record,  1875.) 
(c.)  In  the  small  village  of  Lausen,  in  Switzerland, 
there  occurred  an  outbreak  of  enteric  fever  in  1871  which 
proved  that  even  filtration  through  a  considerable  tract 
of  porous  soil  will  not  purify  water  which  has  once"  been 
specifically  tainted.  It  was  found,  when  the  outbreak 
was  investigated,  that  all  the  houses  in  the  village,  with 
the  exception  of  six,  were  supplied  with  water  by  means 
of  wooden  pipes,  from  a  certain  spring,  and  that  the  out- 
break was  confined  to  the  inhabitants  who  drank  this 
spring-water,  the  other  inhabitants,  who  drank  well-water, 
having  entirely  escaped.  That  the  disease  had  been  in- 
troduced by  -the  spring- water  was  made  clear  by  the  fol- 
lowing facts : — Behind  the  village  there  is  a  hill  about 
300  feet  high,  the  westerly  spur  of  which  extends  into  a 
small  side  valley,  and  through  this  valley  runs  the  Furler 
brook.  Connected  with  this  brook  there  were  the  latrines 
of  several  scattered  farm-houses,  in  one  of  which  four 
persons  had  suffered  from  enteric  fever  in  the  months  of 
June  and  July.  Although  at  first  sight  it  did  not  seem 
possible  that  there  could  be  any  connection  between  these 


220  IMPURE  WATER, 

cases  and  the  outbreak  at  Lausen,  it  was  ascertained  that 
when  the  meadows  in  the  Furler  valley  were  watered  by 
damming  up  the  brook,  the  spring  increased  in  amount, 
and  that  when  they  were  thus  treated  in  July,  it  yielded 
a  turbid  and  bad -tasting  water.  Not  long  afterwards, 
namely,  on  August  7,  10  inhabitants  were  attacked,  and 
in  nine  days  more  5  7  persons  were  prostrated  with  the 
disease,  the  number  reaching  to  130  at  the  end  of  October. 
To  prove  that  the  Furler  brook  could  contaminate  the. 
spring  at  Lausen,  the  experiment  was  tried  of  putting 
common  salt  into  the  brook,  when  it  was  discovered 
that  the  spring  water  became  quite  briny. — (Deutsch. 
Arch,  fur  Klin.  MerL,  1873.) 

(d.)  In  the  early  part  of  the  year  1879  there 
occurred  a  severe  outbreak  of  enteric  fever  at  Caterham 
and  Kedhill  in  Surrey,  in  which,  within  a  period  of 
about  six  weeks  there  were  about  370  cases  and  21 
deaths.  The  outbreak  was  investigated  by  Dr.  Thome, 
and  his  report,  apart  from  its  painstaking  nature,  is  of 
special  interest,  inasmuch  as  the  disease  was  brought 
about  under  conditions  which  stand  alone  in  the  history 
of  such  epidemics.  Before  Dr.  Thome  commenced  his 
inquiries,  Mr.  Jacob,  the  medical  officer  of  health  for  the 
combined  Surrey  sanitary  districts,  had  come  to  the  con- 
clusion that,  as  regards  Kedhill  at  least,  which  was  under 
his  supervision,  there  could  be  little  doubt  that  the 
disease,  judging  from  its  incidence,  was  associated  with 
the  public  water-supply.  That  supply,  like  the  supply 
for  Caterham,  was  derived  for  the  most  part  from  deep 
wells  belonging  to  the  Caterham  Waterworks  Company, 
and  after  inquiring  into  other  probable  sources  of  the 
disease,  such  as  the  drainage  and  milk-supply,  the  evi- 
dence became  quite  conclusive  that  it  had  been  caused 
by  the  use  of  this  water.  But  this  view  received  no 
support,  either  from  consideration  of  the  source  of  the 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  221 

supply  or  from  its  course  or  mode  of  distribution.  It 
was  derived  from  wells  over  500  feet  in  depth,  there  was 
no  evidence  that  there  had  been  leakage  into  them  from 
any  neighbouring  cesspits,  the  supply  was  constant,  and 
no  accidental  contaminations  could  be  ascertained  con- 
nected with  the  mains.  But  while  the  probable  causation 
of  the  epidemic  was  thus  being  gradually  narrowed,  certain 
circumstances  came  under  Dr.  Thome's  notice  which  led 
to  inquiries  in  quite  an  unexpected  direction.  It  appears 
that  during  the  latter  part  of  1878  and  the  beginning  of 
1879  the  Caterham  Waterworks  Company  constructed  an 
adit  from  one  of  their  old  wells  leading  to  a  new  bore 
which  was  then  being  sunk.  A  number  of  men  were 
employed  in  the  construction  of  this  adit,  and  inquiry  was 
made  as  to  whether  any  of  them  had  ailed  while  the  work 
was  going  on,  when  it  was  ascertained  that  one  of  them 
had  left  the  work  some  time  in  January,  and  was  believed 
to  have  been  ill.  This  man  was  sought  out  by  Dr. 
Thorne  and  Mr.  Jacob,  and,  on  being  questioned,  stated 
that  he  worked  in  the  adit,  that  up  to  January  5th  he 
was  quite  well,  but  about  that  date  began  to  suffer  from 
diarrhoea,  aching  pains  all  over,  loss  of  appetite,  shiverings 
followed  by  feelings  of  feverish  heat,  and  gradual  prostra- 
tion. Nevertheless,  he  continued  at  his  work  up  till 
January  20,  the  diarrhoea  all  the  while  being  of  a  most 
persistent  character,  and  so  liquid  at  times  that  it  occa- 
sionally "  ran  from  him."  While  the  work  was  going  on 
it  was  expected  that  all  the  men  who  were  employed  in 
the  adit  should  make  such  preparation  before  descending 
the  well  that  no  occasion  should  exist  for  relieving  them- 
selves below,  but  should  any  such  occasions  arise,  the 
buckets  employed  in  excavating  were  to  be  used.  Now, 
this  man  admitted  that  he  was  compelled  to  evacuate  in 
the  adit  at  least  two  or  three  times  each  shift,  and  though 
he  denied  that  he  ever  did  so  without  using  a  bucket, 


222  IMPURE  WATER, 

"  there  were  undoubted  means  by  which  his  evacuations 
could  have  found  their  way  into  the  water."  Although 
he  was  not  attended  by  any  medical  man,  there  could  be 
little  doubt,  therefore,  that  all  this  while  he  was  suffering 
from,  a  mild  form  of  enteric  fever,  and  it  was  further 
ascertained  that  on  December  25  and  26  he  paid  a  visit 
to  some  friends  in  Croydon,  where  he  had  undoubted 
opportunity  of  contracting  the  disease.  All  these  circum- 
stances are  then  summed  up  as  follows : — 

"  Here  then  were  the  stools  of  an  enteric-fever  patient, 
from  about  January  5  onwards,  getting  into  the  Cater- 
ham  Company's  water,  and  distributed  with  that  water  to 
the  district  served  by  the  company. 

"Now  we  know  from  ample  experience  that  enteric 
fever  is  produced,  and  produced  with  the  maximum  of 
certainty,  when  the  specific  evacuations  of  that  disease  are 
consumed  by  a  population.  Again,  it  is  a  matter  of 
experience  that  where  enteric  fever  has  been  conveyed 
through  water,  some  fortnight  has  to  elapse  between  the 
distribution  of  the  water  and  the  occurrence  of  the  disease 
among  the  community  served  by  it.  But  a  fortnight 
after  January  5  is  the  very  day  when  the  first  case  of 
fever  occurred,  and  during  the  fortnight  following  upon 
the  period  January  5  to  20,  i.e.  from  January  19  to 
February  3,  the  disease  became  widely  spread  through- 
out Caterham  and  Eedhill ;  the  distribution  of  the 
.fever  being  limited,  as  we  have  already  seen,  to  houses 
supplied  with  the  water  of  the  Caterham  Company. 
There  can,  I  think,  be  no  doubt  but  that  we  have  in  the 
man  J.  K.  the  cause  of  the  disease  which  followed." 

There  are  other  points  of  great  interest  in  this  mas- 
terly report,  some  of  them  explaining  what  at  first  sight 
might  be  called  the  capricious  spread  of  the  disease,  but 
all  of  them  go  to  prove  that  the  evacuations  of  this  work- 
man were  the  sole  cause  of  the  epidemic,  while  the  re- 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  223 

medial  measures  which  Dr.  Thome  recommended  were 
speedily  followed  by  a  complete  cessation  of  the  outbreak. 

(e.)  During  the  summer  and  autumn  of  1882,  a  very 
extensive  outbreak  of  enteric  fever  prevailed  in  Bangor 
and  the  immediate  neighbourhood,  which  forms  the  sub- 
ject of  a  special  report  by  Dr.  Barry,  one  of  the  Local 
Government  Board  Inspectors.  The  initial  cause  of  the 
outbreak,  as  previously  traced  by  Mr.  Eees,  the  Medical 
Officer  of  Health  for  the  Carnarvon  combined  districts, 
was  found  to  be  due  to  specific  pollution  of  the  public 
water-supply,  which  is  obtained  from  a  small  stream  called 
the  Afon  Gaseg.  It  appeared  that  towards  the  end  of 
May  a  case  of  illness  which  was  subsequently  confirmed 
to  be  enteric  fever,  occurred  in  a  detached  house  at 
Llwynrhandir,  and  the  drain  from  this  house  discharged 
into  a  small  rapid  stream,  which  in  its  turn  discharged 
into  the  Gaseg  at  a  point  about  350  yards  above  the 
intake  of  the  Bangor  water-supply,  the  whole  distance 
from  the  house  to  the  intake  being  about  700  yards. 
The  incidence  and  simultaneous  appearance  of  the  disease 
in  various  districts  and  streets  at  once  suggested  some 
common  medium  of  infection,  and  all  the  facts  pointed 
clearly  to  a  tainted  water-supply.  The  main  points  con- 
nected with  the  outbreak  are  summarised  by  Dr.  Barry 
as  follows : — 

"  (1.)  That  the  original  case  at  Llwynrhandir,  which 
began  on  the  22d  May,  had  probably  been  passing  in- 
fected matter  into  the  Gaseg,  to  a  greater  or  less  extent, 
from  that  date  until  June  30th. 

"  (2.)  That  prior  to  June  26th,  two  further  cases  had 
occurred  in  the  same  house,  and  that  in  these,  owing  to 
the  mildness  of  the  disease,  no  precautions  had  been 
taken,  and  the  danger  of  infected  matter  passing  into  the 
stream  had  been  thereby  much  increased. 

"  (3.)  That  owing   to   the   flushing    and   consequent 


224  IMPURE  WATER, 

bursting    of    the    water    main,    considerable    disturbance 
occurred  in  the  water-supply  on  June  30th  and  July  1st. 

"  (4.)  Finally,  that  a  simultaneous  outbreak  in  various 
new  localities  occurred  from  ten  days  to  a  fortnight  after 
this  took  place." 

The  first  period  of  the  outbreak,  which  extended  from 
the  last  week  in  May  to  the  end  of  the  first  week  in  July, 
was  characterised  by  a  continued  series  of  dropping  cases 
occurring  simultaneously  in  different  parts  of  the  town 
and  district.  During  this  period  there  was  every  reason 
to  believe  that  a  considerable  amount  of  the  infected 
material  was  retained  in  the  very  imperfect  filtering  beds, 
and  when  these  were  disturbed  after  the  bursting  of  the 
water-main,  the  water  became  impregnated  to  a  much 
more  dangerous  extent,  and  hence  the  sudden  outbreak 
which  characterised  the  second  period.  After  a  time  the 
sewers  became  seriously  infected,  and  no  doubt  the  disease 
was  subsequently  spread  in  this  way,  though  the  tardy 
action  of  the  sanitary  authority  in  cutting  off  the  source 
of  pollution,  and  removing  the  filtering  material,  contri- 
buted to  swell  the  alarming  dimensions  of  the  outbreak. 
Altogether  the  number  of  cases  amounted  to  540,  out  of 
a  population  of  about  10,000  in  the  town  and  infected 
neighbourhood,  and  of  these  42  had  proved  fatal  up  to 
September  12th.  In  stamping  out  the  t  outbreak,  it  may 
be  added  that  tents  were  largely  used  for  isolating  the 
patients. — (Special  Report  to  Local  Government  Board?) 

The  following  outbreak  merits  particular  notice,  on 
account  of  its  unique  character,  and  as  being  the  first  of 
the  kind  reported.  During  the  course  of  the  first  week 
in  August  1882,  Mr.  George  Fosbroke,  medical  officer  of 
health  for  the  combined  Stratford-on-Avon  districts,  was 
called  upon  to  investigate  an  outbreak  of  enteric  fever 
which  had  suddenly  assumed  unusually  extended  propor- 
tions in  the  town  of  Evesham  and  the  adjoining  neigh- 


AND  ITS  EFFECTS  OX  PUBLIC  HEALTH.  225 

bourhood.  Before  the  close  of  September  as  many  as 
forty- eight  cases  had  occurred  in  the  borough,  and  twenty- 
one  in  the  rural  districts,  five  of  the  former  and  three  of 
the  latter  having  proved  fatal.  The  suddenness  of  the 
outbreak,  widely  scattered  though  many  of  the  cases  were, 
pointed  to  some  common  cause ;  and  after  careful  inquiry 
Mr.  Fosbroke  discovered  that  all  of  the  patients  first 
attacked  had  attended  a  regatta  held  at  Evesham  on  July 
12th,  and  further,  that  they  had  all  frequented  a  parti- 
cular meadow  adjoining  the  river  Avon.  Still  more  ex- 
tended inquiry  disclosed  the  fact  that  all  these  persons 
had  partaken  of  "  spirits,  lemonade,  or  ices  "  while  on  the 
meadow,  and  that  the  water  used  either  for  diluting  the 
spirits  or  manufacturing  the  lemonade  and  ices  was  ob- 
tained from  a  well  which  was  subsequently  found  to  be 
contaminated  with  sewage ;  but  whether  specifically  con- 
taminated was  not  quite  clear,  although  suspicions  strongly 
pointed  in  that  direction.  In  any  case,  there  is  no  doubt 
that  the  water  from  this  well  used  for  the  manufacture  of 
the  lemonade  was  the  cause  of  the  outbreak,  and  subse- 
quently, by  direct  or  indirect  means,  affected  no  less  than 
113  persons. — (Mr.  Fosbroke's  Report  for  1882.) 

But  in  country  districts  there  occur  many  scattered 
cases  of  enteric  fever,  which,  although  they  have  a  water 
origin,  cannot  be  traced  to  specifically  polluted  water. 
According  to  my  own  experience,  and  it  accords  with 
that  of  many  other  health  officers  who  have  studied  the 
etiology  of  enteric  fever  in  rural  districts,  the  disease  is 
frequently  produced  by  drinking  water  which  is  found  to 
be  polluted  with  animal  matter,  but  not  with  specifically 
tainted  matter.  As  regards  these  cases,  the  most  careful 
inquiry  has  failed  to  discover  any  connecting  link  between 
them  and  pre-existing  cases,  while  in  all  of  them  it  has 
been  found  that  the  well-water  has  been  polluted  by 
leakage  from  some  cesspool,  privy,  or  drain.  It  may  be 

Q 


226  IMPURE  WATER, 

said,  therefore,  that  though  they  are  essentially  pythogenic, 
they  are  not  specific.  All  this,  however,  will  be  discussed 
more  fully  in  a  subsequent  chapter  (see  Chap.  XIV.) 

3.  Diphtheria. — Although  .the  etiology  of  this  disease, 
especially  as  regards  several  recent  outbreaks,  has  been  by 
no  means  clearly  established,  there  are  grounds  for  believ- 
ing that  it  is  frequently  associated  with  polluted  water. 
Certainly  the  majority  of  the  sporadic  cases  which  have 
come  under  my  own  notice  have  occurred  at  houses  where 
polluted  well-water  was  the  only  cause  which  could  be 
discovered,  and  from  the  answers  sent  in  reply  to   the 
circular  issued  in  1878  by  the  Society  of  Arts  with  refer- 
ence to  our  National  Water  Supply,  it  appears  that  there 
are  a  good  many  other  medical  officers  of  health  who  hold 
similar  views.      In  an  outbreak  at  Kirkella  in  Yorkshire, 
which  was  investigated  on  behalf   of  the  Local  Govern- 
ment Board  by  Dr.  Blaxall,  there  was  reason  to  believe 
that  the  water-supply  of  the  school  had  been  implicated 
in   the  causation  of  the  disease,  while   other  outbreaks 
have  been  instanced  having  a  similar  probable  origin. 

4.  Dysentery. — The   instances   of   outbreaks   of   this 
disease  which  have  been  traced  to  the  presence  of  animal 
impurities  in  drinking  water  are  so  numerous,  especially 
in  Eastern  countries,  that  the  mere  mention  of  the  fact 
will  suffice. 

5.  Diarrhoea. — In  addition  to  outbreaks  occasioned 
by  direct  sewage  contamination,  there  are  several  recorded 
cases  of  the  following  description  : — In  the  Salford  Jail 
there  was  a  sudden  outbreak  of  diarrhoea  of  a  choleraic 
type,  which  affected  57  per  cent  of  the  prisoners,  while 
of  the  officers  and  their  families,  who  were  distributed 
throughout  the  building,  not  one  was  attacked.     The  food 
of  the  prisoners  was  examined  and  found  to  be  good ;  it 
was  evident  also  that  the  air  did  not  contain  the  cause  of 
the  disease,  for  both  classes  were  under  the  same  conditions 


AND  ITS  EFFECTS  ON  PUBLIC  HEALTH.  227 

in  that  respect;  suspicion  was  therefore  directed  to  the 
drinking  water.  It  was  then  discovered  that,  though  the 
water  supplying  all  parts  of  the  prison  was  derived  from 
the  same  source,  there  was  one  cistern  for  the  use  of  the 
officers,  and  another  covered  cistern  to  supply  the  prison- 
ers, and  that  the  untrapped  overflow-pipe  of  the  latter 
communicated  with  an  open  sewer.  On  the  day  of  the 
outbreak  the  water  from  this  cistern  was  observed  to  be 
coloured,  and  to  taste  unpleasantly.  It  had  obviously 
absorbed  sewer-gas,  which  had  ascended  through  the  over- 
flow-pipe ;  and  that  this  had  been  the  real  cause  of  the 
disease  was  confirmed  by  the  fact  that  the  outbreak  dis- 
appeared almost  as  rapidly  as  it  commenced,  when  the 
cistern  was  emptied  and  the  pipe  efficiently  trapped. — 
(Second  Report  of  the  Medical  Officer  of  the  Privy  Council.) 

According  to  my  own  experience,  much  of  the  diarrhoea 
which  prevails  in  country  districts  during  the  summer  and 
autumn  amongst  children  is  due  to  polluted  water  drunk 
either  as  it  is  drawn  from  the  well  or  when  mixed  with 
milk. 

Concluding  Remarks. — Although  an  attempt  has  thus 
been  made  to  classify  roughly  the  hurtful  impurities  of 
water,  and  the  diseases  which  they  may  severally  produce, 
it  need  hardly  be  said  that  in  the  great  majority  of  in- 
stances of  faulty  sanitation  connected  with  water-supply, 
there  is  often  a  combination  of  impurities  and  of  diseases 
both.  For  example,  the  analysis  of  waters  which  have 
proved  to  be  decidedly  injurious  shows  that  in  general  the 
impurities  are  numerous ;  and,  on  the  other  hand,  not  one 
but  several  diseases  may  be  either  directly  produced  or 
indirectly  influenced  by  them.  And  this  difficulty  of 
apportioning  to  special  impurities  their  special  effects  is 
frequently  increased  by  the  presence  of  other  causes  of 
disease.  Thus,  the  water  may  not  only  be  polluted,  but 
the  supply  may  be  scanty ;  and  thereby  give  rise  to  great 


228  IMPURE  WATER,  ETC. 

want  of  cleanliness  of  the  person,  of  clothes,  of  cooking 
utensils,  and  of  the  general  surroundings ;  while  over- 
crowding, defective  sewage  -  removal,  badly  ventilated 
drains,  and  other  causes  of  disease,  may  also  co-operate  in 
seriously  affecting  the  health  of  a  community  and  largely 
increasing  the  death-rate. 

Amongst  other  diseases  which  have  frequently  a  water 
origin  may  be  mentioned  ulcerated  sore  throat,  low  fever, 
and  erysipelas.  Indeed,  in  purely  country  districts  what 
is  known  as  low  fever  is  essentially  a  filth  fever,  and  is 
found  to  be  produced  in  the  great  majority  of  instances 
by  polluted  well-water. 

It  would  also  appear  that  the  prevalence  of  calculous 
disease  and  gravel  bears  some  relation  to  the  amount  of 
lime  and  magnesian  salts  contained  in  the  drinking-water 
of  certain  parts  of  the  country.  This  disputed  subject  has 
been  carefully  investigated  by  Dr.  Murray  of  Newcastle- 
upon-Tyne  (Brit.  Med.  Journal,  1872);  and  his  state- 
ments, together  with  the  cases  which  he  adduces,  are 
strongly  corroborative  of  this  view,  but  general  statistical 
evidence  is  wanting. 

Finally,  it  has  to  be  noted  that  several  of  the  entozoa 
find  their  way  into  the  body  through  the  agency  of  drink- 
ing-water, as  for  instance  the  BothriocepJialus  latus  and 
the  Ascaris  lumbricoides.  The  latter,  which  is  known  as 
the  round  worm,  I  have  found  to  be  common  in  districts 
where  the  water-supply  is  chiefly  obtained  from  shallow 
dip  wells. 


DWELLINGS.  229 


CHAPTEK  IX. 

y  DWELLINGS. 

THE  vast  importance  attaching  to  the  sanitary  conditions 
of  dwellings  has  already  been  frequently  alluded  to  in 
previous  chapters.  Diseases  arising  from  unhealthy  site, 
from  insufficient  ventilation  or  overcrowding,  from  tainted 
or  stinted  water-supply,  from  defective  drainage,  or  from 
accumulations  of  filth,  are  all  of  them  associated  with 
habitations  which  are  faulty  in  their  situation,  construc- 
tion, or  management. 

SECTION  I. — SITE. 

In  choosing  a  site,  special  attention  should  be  paid  to 
the  nature  of  the  soil  and  the  general  conformation  of  the 
ground.  Soils  in  order  of  healthiness  may  be  approxi- 
mately classed  as  follows  : — Those  overlying  the  primitive 
rocks,  clay  slate,  millstone  grit  and  oolite,  gravel  and 
loose  sands,  chalk,  sandstone,  limestone,  and  clays.  The 
soil,  if  not  dry,  should  be  drained,  and  all  hollows  wherein 
water  is  likely  to  lodge  should  be  avoided.  For  these  and 
other  reasons,  the  best  situation  for  a  house  is  on  rising 
ground,  with  trees  in  the  immediate  neighbourhood,  but 
not  so  close  as  to  interfere  with  the  free  movement  of  the 
surrounding  air.  The  aspect  will  very  likely  be  influenced 
in  great  measure  by  the  view  to  be  obtained  from  the 
front  windows,  but  it  is  preferable  that  a  house  should 


230  DWELLINGS. 

face  east  or  south-east,  because  in  the  morning  the  rays 
of  the  sun  penetrate  to  the  front  rooms,  and  in  the  after- 
noon they  cheer  those  at  the  back.  "When,  on  the  other 
hand,  a  house  faces  south,  the  front  rooms  are  over- 
heated in  summer  by  the  rays  of  the  noontide  sun,  while 
those  at  the  back  are  deprived  altogether  of  sunlight. 
Further,  it  is  very  essential  in  country  districts  that  it  be 
first  ascertained  that  a  good  supply  of  wholesome  water 
is  procurable,  and  that  there  are  no  difficulties  in  respect 
to  efficient  drainage.  If  the  subsoil  is  at  all  damp,  it 
should  be  drained  by  suitable  earthenware  field-pipes,  but 
care  should  be  taken  not  to  connect  with  house  drains 
unless  under  strict  precautions  as  to  disconnection  and 
ventilation. 

In  towns,  a  great  evil  sometimes  arises  from  building 
on  rubbish  containing  vegetable  matter  which  has  been 
used  to  fill  up  the  excavations  made  in  brickmaking. 
Thus,  in  1872,  Mr.  Crossby  reported  that  the  high  rate  of 
mortality  in  Leicester  during  the  autumnal  months  was 
chiefly  due  to  an  annual  visitation  of  infantile  diarrhoea 
which  prevailed  in  parts  of  the  town  built  on  such  refuse ; 
and  he  distinctly  attributed  the  disease  to  this  cause.  It 
is  also  worthy  of  special  notice  that  this  opinion  has 
since  been  fully  corroborated  by  the  very  elaborate 
and  painstaking  report  presented  by  Dr.  Buck  and  Mr. 
Franklin  on  the  epidemic  of  diarrhoea  which  prevailed  in 
that  town  during  the  summer  and  autumn  of  1875. 
Further,  the  evidence  of  Drs.  Parkes  and  Sanderson,  in 
their  valuable  report  on  the  sanitary  condition  of  Liver- 
pool, though  negative  as  regards  the  effects  of  cinder- 
refuse  on  the  health  of  the  occupants  of  houses  built  upon 
it,  clearly  points  to  the  conclusion  that  such  a  soil  is 
objectionable,  at  any  rate  when  first  laid  down.  With 
regard  to  this  point  they  advised  the  Town-Council  to 
adopt  the  following  rules  : — 


DWELLINGS.  231 

"  1.  No  excavation  should  be  used  for  the  reception 
of  cinder -refuse  unless  it  is  efficiently  drained.  This 
appears  to  us  to  be  of  especial  importance  in  relation  to 
the  filling  up  of  brickfields.  It  is  well  known  that  the 
whole  of  the  surface  of  clay  is  never  removed,  and  there 
is  always  sufficient  to  form  an  impermeable  basin,  in 
which,  in  the  absence  of  drainage,  water  constantly  col- 
lects. We  hold  it  to  be  of  the  greatest  importance  for 
the  rapid  decomposition  of  whatever  offensive  material 
may  exist  in  the  '  cinder/  that  it  should  be  able  to  become 
dry.  The  only  way  in  which  this  can  be  promoted  or 
secured  is  by  efficient  subsoil  drainage. 

"2.  As  the  vegetable  and  animal  matter  contained  in 
the  cinder -refuse  decays  and  disappears  in  about  three 
years,  and  is  virtually  innocuous  before  that  time,  we 
recommend  that  places  filled  up  with  cinder -refuse  shall 
not  be  built  upon  for  at  least  two  years  from  the  date  of 
last  deposit.'" 

They  also  advised  that  road  -  scrapings  should  not  be 
mixed  with  the  cinder -refuse,  and  that  the  scavenging 
department  should  be  more  careful  with  regard  to  the 
selection  of  material. 

It  need  hardly  be  said  that  wells  sunk  in  made-up 
soils  of  this  description  can  only  yield  a  water  which  is 
highly  polluted  and  altogether  unfit  for  use. 

SECTION  II. —  STRUCTURAL  ARRANGEMENTS. 

In  building  on  a  site  which  has  already  been  occu- 
pied, great  care  should  be  taken  to  make  a  thorough 
examination  of  the  ground,  so  that  no  cesspits,  rubble 
drains,  or  old  wells,  may  escape  notice.  Every  old  drain 
should  be  taken  up,  all  removable  filth  cleared  away,  and 
every  pit  thoroughly  cleaned  out  and  filled  in  with  con- 
crete. 


232  DWELLINGS. 

Unless  absolutely  necessary,  no  drain  should  traverse 
the  basement  of  a  house;  and  when  it  is  necessary,  as 
when  houses  are  joined  together  in  streets  or  squares, 
every  such  drain  should  be  made  absolutely  air  and  water 
jight.  Pipes  of  glazed  earthenware  are  best  suited  for 
the  purpose,  and  should  not  be  less  than  four  inches  in 
diameter.  They  should  be  laid  on  a  bed  of  concrete  made 
with  ground  lime  or  cement,  securely  jointed,  and  covered 
with  concrete.  They  should  also  be  provided  with  full 
means  of  ventilation  at  either  side  of  the  basement.  When 
they  pass  through  foundation  walls  it  is  advisable  that 
relieving  arches  should  be  turned  over  them,  because  it 
often  happens  that  they  become  broken  by  settlements,  or 
during  the  consequent  underpinning.  Outside  the  build- 
ing the  pipes  should  be  laid  in  a  water-tight  trench  of 
clay  puddle  or  concrete,  and  should  lie  their  full  diameters 
below  the  subsoil  of  the  basement,  in  order  that  the  lowest 
parts  of  the  house  may  be  efficiently  drained. 

According  to  the  new  model  by-laws  of  the  Local 
Government  Board,  provision  should  be  made  for  at  least 
two  untrapped  openings  to  the  house-drains,  so  as  to  ensure 
the  constant  flow  of  a  current  •  of  fresh  air  through  them. 
One  such  opening  should  communicate  with  the  drains  by 
means  of  a  suitable  pipe,  shaft,  or  disconnecting  chamber, 
and  be  situated  as  near  as  may  be  practicable  to  the  trap, 
which  should  be  provided  between  the  main  drain  and 
the  sewer.  This  trap  is  generally  a  syphon  trap,  and  the 
ventilating  opening,  whether  pipe,  shaft,  or  simple  cham- 
ber, should  be  situated  on  that  side  of  the  trap  which  is 
nearer  the  building.  The  second  opening  is  to  be  provided 
by  a  vertical  pipe  or  shaft,  at  least  four  inches  in  diameter, 
situated  as  far  distant  from  the  other  opening  as  possible 
— that  is,  at  the  upper  extremity  of  the  drain — and  carried 
to  a  height  of  at  least  ten  feet,  but  so  as  to  avoid  the  risk 
of  discharging  any  sewer  air  into  any  window  of  the  house 


DWELLINGS. 


233 


or  adjoining  building.  When  the  soil-pipe  enters  the 
drain  at  the  farther  end,  it  will  fully  answer  the  purpose 
of  this  second  ventilator,  as  shown  at  B  in  Fig.  5.  Instead 
of  the  open  grating  at  A,  a  ventilating  pipe  or  shaft  may 


WASTE     PIPE    FROM 
SAFE   UNDER    BATH 


Fig.  5.    (After  ROGERS  FIELD,  M.  Inst.  C.E.) 

be  provided,  as  when  houses  abut  on  a  street,  but  in 
either  case  facilities  are  thus  afforded  for  the  passage  of 
a  constant  current  of  fresh  air  through  the  entire  length 
of  house-drain,  and  the  entrance  of  sewer  air  into  the  house 


234 


DWELLINGS. 


is  rendered  practically  impossible.  Fig.  5  also  shows  the 
arrangements  for  overflow  from  cistern,  and  disconnection 
of  pipes  from  sink  and  bath. 

To  facilitate  inspection,  the  outside  track  should  be 
provided,  at  suitable  intervals,  with  access  pipes  or  man- 
holes. These  are  of  various  patterns,  but  all  of  them 
permit  an  easy  opening  into  the  drain,  so  that  deposits  or 
obstructions  can  be  readily  removed.  To  prevent  the 
formation  of  such  deposits,  all  house -drains  should  be 
regularly  flushed,  and  it  is  a  very  good  plan  to  provide  an 
automatic  flushing  tank  at  the  extreme  end  of  the  house- 
drain,  wiiich  could  be  charged  with  slops  from  the  sink, 
or  water  from  a  bath.  (For  further  particulars,  see  Chapter 
XL,  on  Eemoval  of  Sewage.) 

Doulton's  patent  grease  interceptor  (see  Fig.  6),  which 
is  intended  to  receive  sink-slops,  makes  an  excellent  auto- 
matic flush-tank.  It  is  constructed  to  hold  12  gallons, 


Fig.  6. 


is  1  foot  6  inches  in  diameter  and  1  foot  6  inches  high, 
and  comparatively  cheap. 

Where  a  cesspool  is  required  to  receive  the  sewage  of 
a  country  house  provided  with  water-closets,  it  should  be 


DWELLINGS.  235 

situated  at  a  safe  distance  from  the  building,  made  per- 
fectly water -tight,  and  be  abundantly  ventilated.  The 
plan  of  construction  should  be  on  the  liquid-manure  tank 
principle,  the  walls  being  of  brickwork  set  in  cement, 
surrounded  by  a  clay  puddle,  and  lined  inside  with  a 
coating  of  cement.  Both  roof  and  bottom  should  be 
arched,  the  roof  provided  with  a  manhole,  and  the  bottom 
built  with  a  fall  towards  one  end,  where  a  pump  could  be 
fixed.  The  depth  should  not  exceed  6  or  7  feet,  other- 
wise the  increased  hydrostatic  pressure  would  necessitate 
expensive  walling.  To  separate  the  solids  from  the  liquids 
a  galvanised  iron  wire  diaphragm  or  grating  should  divide 
the  tank  into  two  parts.  All  cesspools  should  be  regularly 
and  frequently  cleaned  out,  and  it  is  of  the  utmost  import- 
ance that  the  drains  should  be  trapped  and  disconnected, 
and  the  soil-pipe  ventilated.  If  the  cesspool  is  situated 
in  a  field  or  orchard  some  distance  from  the  house,  the 
liquid  contents  can  frequently  be  got  rid  of  by  construct- 
ing an  overflow  pipe  leading  into  sub -irrigation  drains, 
either  with  or  without  a  flush-tank.  (See  Chapter  XL) 

If  the  water-supply  is  to  be  derived  from  a  well,  the 
well  and  cesspool  should  be  widely  separated.  In  case  of 
accidental  leakage  it  is  also  necessary  that  the  well  should 
not  be  near  the  house-drains.  To  exclude  subsoil  water, 
the  upper  part  of  a  well  should  be  clay-puddled,  or  made 
otherwise  water-tight,  and  the  mouth  should  be  protected 
against  the  entrance  of  surface-water.  Every  well  should 
be  ventilated  and  provided  with  a  manhole  for  purposes 
of  inspection  and  cleansing. 

After  having  secured  dryness  and  healthiness  of  sub- 
soil, the  next  point  of  importance  which  has  to  be  kept  in 
view  is  the  isolation  of  the  area  upon  which  the  proposed 
dwelling  is  to  be  erected  from  the  subsoil,  and  this  can  be 
effected  in  the  cheapest  and  best  way  by  using  concrete. 
In  order  to  prevent  damp  from  rising  into  the  walls,  a 


236  DWELLINGS. 

damp-proof  course  should  overlay  the  whole  of  the  founda- 
tions. Two  or  three  courses  of  slate  laid  in  the  best 
cement  will  answer  the  purpose,  or,  if  external  symmetry 
in  the  damp-proof  course  be  made  a  desideratum,  tiles 
made  of  highly  vitrified  stoneware  should  be  employed. 
When  there  is  a  basement  story,  it  should  be  isolated 
from  the  ground  by  an  open  space.  The  entrance  of 
underground  damp  may  also  be  prevented  by  constructing 
what  are  called  dry  areas ;  that  is,  by  leaving  a  space 
between  the  main  wall  and  a  thin  outer  wall,  which  reaches 
to  the  ground  level,  the  two  being  joined  together  here 
and  there  by  stretching  bricks. 

As  much  of  the  dampness  in  walls  is  due  to  driving 
wet,  well-planned  houses  are  now  often  built  with  hollow 
walls,  in  which  case  ties  or  bonding  bricks  must  be  laid 
in  at  regular  intervals,  to  render  the  strength  and  stability 
of  the  twin  walls  equivalent  to  a  strong  single  wall. 
With  single  walls,  built  of  soft  porous  material,  the  effects 
of  driving  wet  may  be  obviated  by  slating  or  tiling  them, 
or  by  applying  to  the  outer  surface  one  or  other  of  the 
several  patent  waterproof  compositions  which  are  well 
recommended. 

Perforated  bricks  should  be  introduced  at  suitable 
distances  in  the  outward  walls,  to  admit  air  to  the  joists 
and  beneath  the  flooring. 

One  of  the  gravest  faults  in  the  construction  of  even 
the  better  class  of  houses  in  the  present  day  is  the  little 
attention  which  is  paid  to  the  position  and  arrangements 
of  water-closets.  They  are  too  frequently  situated  in 
out-of-the-way  corners,  where  only  borrowed  light  can  be 
obtained,  and  efficient  ventilation  is  impossible.  The  best 
position  is  in  an  isolated  block,  built  tower  fashion,  and 
abutting  against  the  outer  wall  of  the  house,  with  a  closet 
on  each  floor  and  the  supply  cistern  on  the  top.  There 
should  be  an  anteroom  or  passage  between  each  closet  and 


DWELLINGS.  237 

the  house,  large  enough  to  admit  of  sufficient  cross  ven- 
tilation by  means  of  open  windows,  or  windows  provided 
with  ventilating  panes.  A  double  set  of  doors  would  be 
required, —  one  leading  into  the  house  and  the  other 
cutting  off  the  passage  from  the  closet.  The  closet-seat 
should  face  a  window  in  the  outer  wall,  so  that  abundance 
of  light  may  be  secured  for  inspection  with  regard  to 
cleanliness,  and  direct  draught  from  the  window  be  avoided. 
The  window  should  extend  up  to  the  ceiling,  and  have 
double  sashes.  The  closet  may  be  permanently  ventilated 
by  keeping  the  top  sash  drawn  down,  or  by  air-bricks 
inserted  immediately  beneath  the  ceiling.  In  smaller-sized 
houses  the  closet  may  be  simply  projected  from  the  build- 
ing, with  the  seat  facing  the  door,  and  with  two  opposite 
windows  reaching  to  the  ceiling  between  the  seat  and  door. 
Cross  ventilation  and  sufficient  light  would  thus  be  ob- 
tained, without  the  interposition  of  an  anteroom.  All, 
however,  that  is  insisted  on  in  the  model  by-laws  of  the 
Local  Government  Board  is,  that  the  closet  should  be  built 
against  an  outside  wall,  and  be  properly  lighted  and  venti- 
lated. 

There  are  so  many  kinds  of  closets,  well  arranged  in 
all  their  details,  that  it  is  difficult  to  say  which  of  them 
are  most  to  be  recommended.  There  are  others,  again, 
such  as  the  round  hopper  closet-pan,  fixed  into  an  ordinary 
sigmoidal  bend,  which  cannot  be  sufficiently  condemned, 
unless  worked  by  a  very  high  pressure  of  water ;  they 
are  constantly  getting  foul,  and  it  is  seldom  that  the  whole 
of  the  excreta  are  removed ;  indeed,  they  can  seldom  be 
kept  clean  unless  they  are  regularly  flushed  by  a  bucket 
or  pail.  Generally  speaking,  those  closets  are  the  best 
which  provide  for  good  flushing  and  rapid  and  complete 
removal  of  the  excreta,  without  permitting  reflux  of  foul 
air.  Every  closet,  unless  it  be  flushed  by  hand,  should  be 
provided  with  a  cistern,  preferably  of  the  waste-preventing 


238  DWELLINGS. 

kind,  because  it  is  of  the  utmost  importance  that  there 
should  be  no  direct  communication  with  the  water-main. 
It  has  also  to  be  pointed  out  that  the  closet  should  not 
be  supplied  from  the  same  cistern  which  supplies  the 
drinking  water.  The  pan  should  be  roomy  arid  made  of 
white  glazed  earthenware ;  the  machinery  should  work 
easily  and  not  be  apt  to  get  out  of  gear ;  and  the  seat 
should  be  so  framed  as  to  come  asunder  readily  to  permit 
of  inspection.  ~No  closets  should  be  constructed  with 
either  a  "  container  "  or  a  D-trap,  because  both  retain  filth, 
and  thus  become  a  source  of  danger.  Amongst  closets 
which  have  been  highly  commended  may  be  mentioned 
thie  "  Excelsior  Water-Closet ;"  Banner's  Closet ;  Winn's 
Closet ;  Dodd's  Closet ;  Bean's  Household  Closet ;  and 
Twyford's  National  Closet. 

As  soil-pipes  communicate  directly  with  the  drains, 
they  should  be  carried  up  to  the  highest  part  of  the  roof, 
and  be  of  the  same  diameter  throughout.  Efficient  venti- 
lation of  the  drains  is  in  this  way  secured  at  a  most 
important  point,  and  the  pipe  from  the  closet  trap  can  be 
connected  with  the  soil-pipe  without  interfering  with  the 
upward  current  of  sewer-air.  If  the  soil-pipe  cannot  be 
carried  straight  up  to  the  top  of  the  house,  the  bends  or 
angles  should  be  made  as  obtuse  as  possible,  and  in  any 
case  it  should  not  be  plastered  or  built  into  the  wall,  but 
]eft  free  for  inspection  throughout  its  whole  track.  It  is 
obvious  that,  were  this  plan  universally  adopted,  there 
could  be  no  pressure  of  sewer-gas  against  the  closet  trap, 
and  therefore  little  or  no  risk  of  its  entering  into  the 
house  by  this  channel.  The  waste-pipe  from  a  house- 
maid's sink,  intended  to  carry  off  foul  matter,  should  be 
constructed  and  ventilated  like  a  soil-pipe. 
//  It  has  been  urged,  by  way  of  objection  against  this 
plan,  that,  where  houses  are  closely  packed  together,  and 
are  of  different  elevations,  the  sewer-gases  discharged  from 


DWELLINGS.  239 

the  pipes  of  the  lower  houses  would  find  their  way  into 
the  "higher,  and  thus  become  not  only  a  nuisance  but  a 
source  of  danger.  With  ample  sewer-ventilation,  however, 
the  objection  does  not  hold  good,  because  the  sewer  air  is 
so  diluted  as  to  be  inoffensive  and  comparatively  pure. 

With  regard  to  all  other  pipes,  whether  waste-water  // 
pipes,  sink-pipes,  or  pipes  from  lavatories,  it  should  be 
laid  down  as  a  rule  that  none  of  them  should  lead  directly 
into  any  soil-pipe  or  drain.  They  should  be  carried  out- 
side an  external  wall,  and  discharge  in  the  open  air  over 
a  channel  leading  to  a  trapped  gully  grating  at  least  18 
inches  distant.  (See  Fig.  5.)  But  although  the  sewer- 
gases  are  in  this  way  prevented  from  entering  the  house, 
it  is  still  necessary  that  the  sink  and  other  pipes  should 
be  trapped.  Scullery  and  sink  pipes,  for  example,  will 
require  article-intercepting  traps,  and  pipes  to  lavatories 
or  baths  must  be  provided  with  syphon  traps  to  prevent 
the  ingress  of  cold  air.  (See  Fig,  5.) 

All  traps  on  house-drains  should  be  ventilated  either 
by  pipes  carried  to  the  roof  or  parapet  of  the  house,  or 
by  what  is  called  direct  ventilation.  Unless  protected 
in  some  such  way  they  are  comparatively  useless.  (See 
Chap.  XL)  When  a  water-closet  is  dispensed  with,  some 
form  of  dry  or  pail  closet  situated  outside,  and  at  a  safe 
distance  from  the  well  (if  any)  should  be  provided. 

Details  concerning  the  ventilation  and  warming  of  a 
house  have  already  been  given  in  Chapter  IV.,  and  the 
only  points  which  need  be  repeated  are — the  importance 
of  constructing  a  separate  extraction  flue  for  each  room 
in  the  chimney-stalk,  the  desirability  of  inserting  venti- 
lating fire-places,  and  the  great  advantage  of  securing  that 
the  products  of  gas-combustion  be  conveyed  by  special 
channels  into  the  outer  air. 

It  is  needless  to  say  that  the  rooms  in  a  well-con- 
structed and  healthy  house  should  be  spacious,  airy,  and 


240  DWELLINGS. 

light:  <  The  windows  should  reach  to  within  a  short  dis- 
tance of  the  ceiling,  and  should  always  be  made  to  open. 
It  is  preferable  to  have  them  glazed  with  plate  glass,  to 
economise  heat.  No  single  bedroom  should  be  of  less 
dimensions  than  1000  cubic  feet,  nor  should  any  bed- 
stead be  fixed  in  a  recess. 


SECTION  III. — DWELLINGS  FOE  THE  POORER  CLASSES. 

In  constructing  buildings  for  the  poorer  classes,  the 
great  difficulty,  encountered  at  the  very  outset,  consists  in 
providing  the  necessary  accommodation  with  the  requisite 
sanitary  arrangements,  at  a  cost  which  will  allow  of  a 
sufficiently  low  rental.  In  towns  the  original  cost  is 
greatly  increased  by  the  high  price  of  land ;  but  even  in 
country  places,  where  a  site  can  be  procured  at  a  cheap 
rate,  the  cost  for  the  erection  of  a  cottage  of  the  humblest 
pretensions  will  entail  a  rental  which  many  a  labouring 
man  can  barely  meet.  Where  the  ground  rental  is  low, 
the  cheapest  and  most  commodious  form  of  labourer's 
cottage  is  one  without  any  upper  story.  Thus,  according 
to  Mr.  Allen,  in  his  manual  on  Cottage  Building,  a  cottage 
consisting  of  a  living-room  for  general  every-day  use,  a  bed- 
room for  the  labourer  and  his  wife,  a  bedroom  for  boys,  a 
bedroom  for  girls,  a  small  wash-house,  a  store-room  and 
closet,  could  be  built  for  £100,  provided  all  the  rooms  are 
on  the  ground-floor,  and  that  two  such  cottages  be  ranged 
side  by  side,  so  as  to  be  spanned  by  the  same  roof,  and  con- 
tained within  four  walls,  forming  a  simple  parallelogram. 
The  row  of  cottages  proposed  by  Dr.  Hunter  in  the  Seventh 
Eeport  of  the  Medical  Officer  to  the  Privy  Council,  pro- 
vided for  a  front  and  back  kitchen  in  each  cottage,  and 
two  bedrooms  overhead.  The  kitchens  were  to  be  paved 
with  brick  or  tile,  "the  front  about  11  feet  by  11,  by  8 
feet  6  inches  high  ;  the  back  about  1 1  by  8  feet  6  inches. 


DWELLINGS.  241 

Ceiling  would  be  unnecessary.  There  should  be  five  doors 
only,  the  closet  under  the  stairs  one,  each  bedroom  one, 
and  two  house  doors.  There  should  be  four  sliding  win- 
dows, a  grate  with  an  oven,  a  boiler  in  the  back  kitchen, 
a  little  fireplace  in  one  bedroom,  and  a  Welsh  slate  roof, 
the  bedrooms  being  ceiled. 

"  Such  houses  might  be  supplied  for  £50,  or  £1500 
for  the  thirty." 

In  a  paper  read  before  the  Farmers'  Club  in  1874, 
Mr.  Howard  of  Bedford  states  that,  some  few  years  pre- 
viously, he  built  a  block  of  six  cottages  for  his  labourers 
entirely  of  concrete.  The  walls  were  a  foot  thick,  and  in 
consequence  of  the  impervious  nature  of  the  material  they 
were  warmer  and  drier  than  ordinary  brickwork.  Each 
cottage  contained  three  bedrooms,  and  each  was  provided 
with  an  earth-closet  at  the  end,  but  accessible  from  within. 
Exclusive  of  the  closets,  the  cost  of  the  whole  block  was 
a  little  over  £600,  or  £100  per  cottage. 

According  to  the  design  by  Mr.  Birch,  which  obtained 
the  award  of  the  Society  of  Arts  in  1864  for  premiums 
offered  by  Mr.  Bailey  Denton,  the  estimated  cost  of  a  pair 
of  cottages  was  £203,  including  every  requisite  necessary 
to  render  them  complete  and  fit  for  occupation.  On  the 
ground -floor  it  was  proposed  that  there  should  be  a  living- 
room  12  feet  6  in.  by  12  feet;  a  scullery,  containing  a 
copper  for  washing  and  a  sink,  10  feet  5  in.  by  7  feet  6 
in. ;  and  a  small  pantry  and  place  for  fuel  opening  into 
the  scullery.  On  the  chamber  floor  there  were  to  be  three 
bedrooms  with  a  floor-space  respectively  of  12  feet  8  in. 
by  8  feet  6  in. ;  7  feet  8  in.  by  8  feet  6  in.  ;  and  9  feet 
by  8  feet. — (See -Builder,  1864.) 

Owing  to  the  increased  cost  of  materials  and  the  rise 
in  wages,  it  is  very  likely  that  the  above  estimates  would 
be  found  to  be  somewhat  too  low  for  the  erection  of 
similar  cottages  in  the  present  day,  but  if  built  in  blocks 

R 


242  DWELLINGS. 

or  pairs,  I  am  credibly  informed  that  good  cottages  with 
three  bedrooms  can  still  be  erected  for  about  £100. 

In  these  plans,  and  in  fact  in  almost  all  plans  for 
cottage  construction,  the  cubic  space  allowance  is  very 
limited,  so  that  overcrowding,  to  a  greater  or  less  extent, 
is  sure  to  prevail  at  times.  Cottages  which  are  scarcely 
roomy  enough  for  a  married  couple  and  two  or  three 
children  become  occupied  by  much  larger  families,  or  the 
family  increases  in  number  year  after  year,  while  the  bed- 
room accommodation  remains  the  same.  The  initial  space, 
therefore,  should  be  ample  enough  to  meet  the  require- 
ments of,  at  any  rate,  moderate  family  increase  ;  and  when 
a  number  of  such  cottages  are  built  in  the  same  locality, 
they  should  be  of  different  sizes,  to  suit  small  and  large 
families  alike.  The  kind  of  closet  best  suited  for  country 
cottages  is  some  modification  of  the  dry  system,  while  the 
slops,  if  they  do  not  discharge  into  village  drains,  should 
be  utilised  in  the  garden,  or  disposed  of  by  subsoil  irriga- 
tion where  that  is  possible.  All  this,  however,  will  be 
discussed  more  fully  in  Chapter  XI. 

In  large  towns  the  house  accommodation  for  the 
labouring  classes  must  necessarily  be  supplied  in  a  great 
measure  by  what  are  called  tenements,  but  in  this  case 
special  attention  should  be  paid  to  sanitary  arrangements, 
such  as  closet  accommodation,  water-supply,  ventilation, 
and  general  cleanliness  of  premises,  and  a  copy  of  rules 
or  by-laws  should  be  prepared  and  handed  to  each  occu- 
pant. 

Of  equal  importance  with  the  construction  of  dwell- 
ings for  the  labouring  classes  is  the  far  more  difficult 
problem  of  repairing  and  improving  the  unhealthy  abodes 
which,  in  town  and  country  village  alike,  increase  the 
annual  rate  of  mortality  to  an  extent  that  can  hardly  be 
estimated.  It  is  true  that  the  law  already  prohibits  the 
inhabitation  of  the  worst  class  of  dwellings,  such  as  damp, 


DWELLINGS.  243 

dark,  underground  cellars ;  but  there  are  other  dwellings, 
so  numerous  that  their  immediate  demolition  would  deprive 
a  large  proportion  of  the  lower  classes  of  shelter,  which 
no  alterations  or  improvements  can  render  healthy.  They 
are  either  situated  in  narrow,  dingy  alleys,  or  huddled 
together  in  close  courts,  so  as  to  be  practically  unventil- 
able,  or  their  internal  condition  and  constructural  faults 
are  so  grave  as  to  be  beyond  remedy.  Nor  are  these  the 
only  sanitary  defects  connected  with  them  which  have  to 
be  condemned.  It  is  in  these  very  dwellings  that  the 
filth  and  poisonous  effluvia  due  to  overcrowding  are  con- 
stantly accumulating,  and  where  the  germs  of  disease  find 
a  fitting  soil  for  their  development.  The  departmental 
reports  of  the  Privy  Council  afford  numerous  instances  of 
such  a  state  of  things,  and  notably  those  of  Drs.  Hunter, 
Stevens,  and  Buchanan. 

It  is  to  be  hoped  that  the  carrying  out  of  the  provi- 
sions of  the  Artisans'  Dwellings  Act  of  1875  and  1882, 
or  some  similar  measure,  will  eventually  bring  about  a 
marked  improvement  in  this  respect  in  many  of  our  cities 
and  large  towns,  for  hitherto  the  difficulty  of  dealing 
with  what  is  called  "  surface-crowding  "  has  thrown  great 
obstacles  in  the  way  of  reaping  to  the  full  extent  the 
advantages  to  be  gained  from  lessening  the  indoor  over- 
crowding. In  the  worst  parts  of  Liverpool,  according  to  ^ 
Drs.  Parkes  and  Sanderson,  nearly  1000  persons  are 
huddled  together  in  one  acre  of  ground,  and  in  other 
towns,  such  as  Glasgow  and  Greenock,  the  number  per 
acre  in  some  districts  is  quite  as  great.  It  is  clear,  there- 
fore, that  no  improvement  in  the  dwellings,  nor  any  in- 
crease in  the  amount  of  cubic  space  per  head,  will  render 
the  ventilation  as  satisfactory  as  it  should  be,  when  so 
many  houses  are  packed  together  in  such  a  limited  space. 
Demolition  of  old  houses,  the  displacement  of  the  popula- 
tion  into  blocks  of  model  dwellings,  or  into  houses  put 


244  DWELLINGS. 

into  serviceable  repair,  and  the  opening  of  new  streets, 
are  all  necessary. 

As  instances  of  successful  enterprise  in  this  direction, 
it  may  be  mentioned  that  the  London  Improved  In- 
dustrial Dwellings  Company  now  provides  house-accom- 
modation for  over  20,000  persons,  and  that  during  1881 
the  death-rate  averaged  only  16 '4  per  1000;  while  the 
Peabody  Trust  has  provided  accommodation  for  about 
12,000  persons,  and  during  the  same  year  the  death-rate 
averaged  17 '2  per  1000  as  against  21 '2  for  London 
generally. 

In  country  districts,  where  there  is  far  less  excuse  for 
the  existence  of  these  evils,  it  has  been  found  that  in 
reality  they  are  almost  as  glaring  and  wide-spread  as  in 
towns.  The  elaborate  report  of  Dr.  Hunter  on  the  State 
of  the  Dwellings  of  Eural  Labourers  (see  Seventh  Report 
of  Medical  Officer  of  Privy  Council)  may  be  quoted  in 
proof  of  this  statement.  In  all,  5375  cottages  were 
reported  upon.  Of  these,  2195  contained  only  one  bed- 
room ;  2930  contained  two ;  and  only  250  more  than 
two.  The  number  of  persons  resident  in  them,  including 
adults  and  children,  was  24,770,  giving  an  average  of  4' 6 
persons  to  a  house,  or  2*8  to  a  bedroom.  In  the  single- 
bedroomed  houses,  the  average  number  sleeping  in  the 
bedroom  was  4,  2 '2  of  whom  were  adults  and  1/8  child- 
ren. The  average  cubic  space  for  sleeping  accommo- 
dation was  estimated  at  156  feet  per  head.  The  rickety 
state  of  the  great  majority  of  the  hovels  permitted  a 
freer  interchange  of  air  than  in  the  new  cottages,  so  that, 
although  the  cubic  space  per  head  in  the  latter  was  some- 
what larger,  the  contained  air  was  generally  more  impure. 
Indeed,  many  of  the  bedrooms  were  so  much  exposed  to 
the  weather,  that  cases  of  sickness,  when  they  did  occur, 
had  to  be  treated  in  the  kitchen.  But  the  wretched 
sanitary  condition  of  the  dwellings  was  even  a  less  evil 


DWELLINGS.  245 

than  their  numerical  insufficiency.  It  was  found  that 
many  landlords  pulled  down  the  cots  on  their  estates  when 
they  fell  into  decay,  without  providing  others,  and  thus 
forced  the  labourers  to  find  house-room  in  already  over- 
crowded hamlets.  As  a  consequence,  this  huddling  to- 
gether of  human  beings  not  only  presented  numerous  foci 
for  the  development  of  disease,  but  rendered  the  limita- 
tion of  any  contagious  diseases  which  were  introduced  an 
almost  hopeless  task.  That  such  a  state  of  things  con- 
tinues to  exist  in  many  rural  districts  the  reports  of 
medical  officers  of  health  from  all  parts  of  the  country 
show  but  too  clearly,  and  though  there  can  be  no  doubt 
that  the  improvements  which  have  been  carried  out  in 
various  districts  since  the  passing  of  the  Public  Health 
Act  of  1872  have  been  very  considerable,  it  is  impossible 
to  cope  with  the  innumerable  evils  connected  with  defec- 
tive house-accommodation  in  small  towns  and  country 
villages  until  larger  legislative  powers  are  conceded.  As 
I  have  stated  elsewhere,  I  am  strongly  of  opinion  that 
some  measure  akin  to  the  recent  Artisans'  Dwellings  Act 
is  urgently  required  for  rural  and  small  urban  districts. 
"  Let  this  legislative  necessity  be  advocated  as  warmly  as 
it  has  hitherto  been  tacitly  admitted,  and  there  will  be 
no  difficulty  in  drawing  up  a  bill  which,  without  unfairly 
interfering  with  the  rights  of  private  property,  will  give  a 
wholesome  stimulus  to  the  discharge  of  public  obligations  ; 
afford  the  requisite  scope  for  individual  or  conjoint  enter- 
prise in  adapting  old  cottages  and  in  building  new  ones 
where  they  are  required ;  and,  above  all,  empower  and 
impose  it  as  a  duty  on  sanitary  authorities,  which  cannot 
be  evaded,  that  they  themselves  shall  carry  out  the  neces- 
sary improvements  in  localities  where  private  or  conjoint 
enterprise,  aided  if  you  like  by  philanthropic  effort,  may 
prove  inadequate,  or  where  public  obligations  on  the.  part 
of  landowners  are  in  this  respect  persistently  neglected. 


246  DWELLINGS. 

But  it  has  been  urged  that  individual  or  conjoint  enter- 
prise will'  fail  to  be  elicited  because  cottage  property  does 
not  pay  a  sufficient  percentage  on  the  outlay.  Well,  I 
am  quite  willing  to  admit  that  what  are  called  ornamental 
cottages  may  not  pay,  but  ornamental  cottages  are  need- 
lessly expensive,  and  are  built  under  exceptional  circum- 
stances. What  I  do  know  is  this,  that  substantial  and 
comfortable  cottages  can  be  built  in  pairs  or  in  blocks, 
each  containing  three  bedrooms,  at  a  cost  of  about  £100 
per  cottage.  Then,  again,  it  is  very  well  known  that  the 
worst  class  of  cottages,  when  they  get  into  the  hands  of 
small  property  owners,  often  pay  as  much  as  ten  to  fifteen 
per  cent  on  their  outlay ;  so  that,  taking  into  consideration 
the  improved  and  improving  position  of  the  labourer  to 
pay  a  better  rental,  the  fair  return  that  may  even  now  be 
obtained  for  new  cottages,  and  the  comparatively  large 
return  which  is  obtained  for  all  cottages  after  being  put 
into  habitable  repair,  there  is  every  reason  to  believe  that 
there  will  be  no  lack  of  private  or  public  enterprise  in 
the  shape  of  local  building  and  improving  societies,  pro- 
vided only  the  requisite  facilities  for  such  enterprise  be 
legalised  by  Act  of  Parliament." — (See  the  Author's 
pamphlet  on  Sanitary  Defects  in  Enrol  Districts,  and  How 
to  Remedy  them,  and  Dr.  Bond's  Home  of  the  Agricultural 
Labourer.) 

Unfortunately,  too,  many  of  the  evils  connected  with 
house-accommodation  in  rural  districts  threaten  to  become 
perpetuated,  inasmuch  as  rural  sanitary  authorities,  unless 
they  apply  specially  for  urban  powers,  have  no  control 
over  the  erection  of  new  buildings.  Similar  by-laws 
should  be  in  force  with  respect  to  thickness  of  walls, 
height  of  rooms,  ventilation,  drainage,  and  general  sanitary 
arrangements  which  are  carried  out  in  urban  districts. 
Indeed,  it  is  difficult  to  conceive  why  such  control  should 
not  have  been  conceded  to  sanitary  authorities  without 


DWELLINGS.  247 

distinction,  unless  it  be  that  sanitary  legislation  has 
hitherto  been  halting  and  one-sided.  It  is  quite  true  that 
many  sanitary  defects  connected  with  existing  cottages 
can  be  dealt  with  under  the  wide  term  nuisance,  such 
as — the  repair  of  uneven  floors,  and  roofs  that  let  in  the 
rain ;  the  repair  of  dilapidated  walls ;  the  opening  of 
closed  windows;  the  removal  of  privies  and  pig-styes 
which  abut  against  outside  walls ;  the  drying  of  the  sub- 
soil ;  the  repair  of  drains ;  and  the  like.  It  is  likewise 
true  that  if  a  house  cannot  be  put  into  fairly  habitable 
repair  the  law  gives  power  to  close  it ;  but  where  houses 
are  scarce,  it  need  hardly  be  said  that  this  becomes  a  very 
serious  matter,  inasmuch  as  it  either  tends  to  increase 
the  overcrowding  elsewhere,  or  leads  to  displacement  of 
labourers  and  their  families,  an  alternative  which  is 
attended  at  all  times  with  much  inconvenience,  and  very 
frequently  with  great  hardship. 

In  large  towns  this  displacement  of  the  population 
becomes  a  question  which  naturally  affects  the  poorer 
classes  to  a  much  greater  extent  than  in  country  villages. 
Many  extensive  undertakings,  such  as  the  construction  of 
railways  and  new  streets,  while  they  act  beneficially  in 
making  wide  clearances  in  the  crowded  districts,  almost 
of  necessity  conduce  to  overcrowding  in  neighbouring 
parts.  The  families  that  are  thus  rendered  homeless  by 
the  demolition  of  their  dwellings  seek  the  nearest  shelter, 
rents  are  raised  in  consequence  of  the  increased  demand 
for  accommodation,  and  such  as  cannot  afford  to  expend 
more  than  they  did  previously  must  be  contented  with 
homes  even  less  healthy  than  those  which  they  have  been 
compelled  to  leave.  As  a  compensating  measure,  the 
running  of  working  men's  trains  morning  and  evening, 
between  the  suburbs  and  the  town  stations,  although  it 
is  a  step  in  the  right  direction,  does  not  by  any  means 
meet  the  difficulty.  Larger  measures  are  undoubtedly 


248  DWELLINGS. 

required,  and  the  more  thoughtful  amongst  sanitary  re- 
formers are  agreed  in  maintaining  that  no  parliamentary 
powers,  permitting  the  demolition  of  numerous  dwellings 
in  populous  districts,  should  be  granted  unless  the  com- 
panies or  corporations  applying  for  these  powers  provide 
commensurate  and  improved  accommodation  elsewhere, 
and  within  reasonable  distances.  It  is  true  that  many  of 
the  displaced  population  might  not  choose  to  remove  to  the 
new  dwellings,  but  they  should  have  the  option.  Tenants, 
at  all  events,  would  not  be  wanting,  and  that  there  would 
be  no  financial  loss  is  clearly  proved  by  the  profits  gained 
by  private  enterprise  in  building  homes  for  the  working- 
classes,  although  it  must  be  admitted  that  numbers  of 
such  houses,  as  they  are  run  up  in  the  present  day,  can 
scarcely  be  pronounced  habitable.  Urban  sanitary  autho- 
rities have,  however,  full  powers  vested  in  them  by  the 
statutes  to  prevent  the  erection  of  dwellings  that  are 
unwholesome,  and  it  is  their  duty  to  see  that  the  accom- 
modation and  structural  .arrangements  are  in  all  cases 
satisfactory. 

Concerning  the  duties  of  the  medical  officer  of  health 
with  regard  to  overcrowding  and  places  unfit  for  habita- 
tion, together  with  the  sanitary  enactments  dealing  with 
the  same,  see  Chapter  XVI. 

.  SECTION  IV. — SANITARY  INSPECTION  OF  DWELLINGS. 

1.  Diseases  traceable  to  Sanitary  Defects. — There 
are  so  many  diseases,  and  some  of  them  so  fatal, 
associated  with  sanitary  defects  in  or  around  dwell- 
ings, that  it  is  of  the  utmost  importance  that  every 
medical  practitioner,  and  above  all  every  sanitary  official, 
should  be  able  to  detect  these  hidden  dangers,  or  direct 
how  they  may  be  discovered  and  remedied.  Exclusive  of 
new  houses,  which  have  been  erected  in  accordance  with 


DWELLINGS.  249 

well-devised  by-laws,  it  is  no  exaggeration  to  say  that 
in  the  vast  majority  of  houses,  and  especially  good-class 
houses,  sanitary  defects  may  be  found  which  at  any  time 
may  lead  to  the  gravest  consequences,  and  when  disease 
does  break  out  the  wonder  often  is  that  the  inmates 
should  have  escaped  so  long.  Minor  disorders,  such  as 
languor,  headache,  so-called  bilious  attacks,  dyspepsia, 
diarrhoea,  and  slight  ulcerated  sore  throat,  are  frequently 
allowed  to  pass  unheeded,  or  are  treated  as  ordinary 
ailments ;  and  it  is  not  till  disease  of  more  pronounced 
severity  occurs  that  the  sanitary  condition  of  the  house 
becomes  suspected,  and  the  real  cause  is  discovered. 

Apart  from  ailments  which  are  connected  with  damp- 
ness of  site,  foundations,  or  of  walls,  such  as  rheumatism, 
phthisis,  bronchitis,  or  other  lung  affections,  the  class  of 
diseases  which  are  associated  with  faulty  house  sanitation 
are  essentially  filth  diseases,  wh ether  they  originate  de 
novo  or  are  conveyed  by  befouled  air  or  water.  And 
among  these  diseases  may  be  enumerated  the  following  : — 
diphtheria,  ulcerated  sore  throat,  follicular  tonsillitis, 
follicular  stomatitis,  croup,  enteric  and  ill-defined  forms  of 
fever,  diarrhoea  and  dysentery,  erysipelas,  carbuncle, 
abscess,  pyaemia,  hospital  gangrene,  and  puerperal  fever. 
There  is  no  doubt,  too,  that  the  breathing  of  vitiated 
air,  whether  depending  upon  overcrowding,  defective 
ventilation,  or  the  entrance  of  sewer  gas,  not  only 
induces  phthisis,  pneumonia,  and  other  lung  affections, 
but  largely  influences  the  spread  of  zymotic  disease  and 
the  severity  of  all  kinds  of  diseases,  however  they 
may  have  been  originated  in  the  first  instance.  Pneu- 
monia, is  frequently  engendered  by  impure  air,  and  it  is 
now  generally  admitted  that  this  filth-pneumonia,  as  it 
may  be  called,  is  infectious,  and  occasionally  becomes 
epidemic.  Then,  again,  there  can  be  little  doubt  that  it 
is  this  influence  which  changes  pleurisy  into  empyema, 


250  DWELLINGS. 

simple  bronchitis  into  broncho -pneumonia,  and  which 
serves  to  explain  the  frequency  with  which  lung  affec- 
tions are  associated  with  various  infectious  diseases,  such 
as  smallpox,  measles,  whooping-cough,  and  enteric  fever. 

2.  Sanitary  Defects  in  and  around  dwellings. — As 
regards  the  defects  themselves,  they  are  of  every  variety 
and  extent,  and  many  of  them  palpable  enough.  Damp 
foundations,  damp  walls,  imperfect  ventilation,  windows 
not  made  to  open,  roofs  dilapidated  and  out  of  repair, 
floors  uneven,  general  uncleanliness,  overcrowding — all 
these  constitute  nuisances  which  are  especially  common 
in  the  dwellings  of  the  poorer  classes  in  town  and 
country  districts  alike.  Then,  if  there  is  no  sink  inside 
the  dwelling,  there  is  generally  a  drain  near  the  front  or 
back  door  to  remove  the  slops,  which  is  so  badly  laid  and 
trapped  that  foul  smells  are  constantly  given  off,  and 
these  are  often  aggravated  by  other  nuisances.  In 
country  districts,  for  example,  pig -styes,  byres,  and 
manure -heaps  are  frequently  so  close  to  the  dwellings 
that  the  inside  air  is  always  more  or  less  tainted.  The 
closet  accommodation,  again,  consists  either  of  a  foul 
privy,  which,  though  sufficiently  far  removed,  is  so  offen- 
sive that  it  cannot  be  used  without  risk,  or  of  a  privy 
and  deep  ash-pit  close  to  the  house  and  in  dangerous 
proximity  to  the  well.  Indeed,  pollution  of  the  well- 
water  from  closets,  leaky  drains,  or  manure-pits  in  farm- 
yards, is  the  principal  cause  of  the  majority  of  the  spor- 
adic cases  of  enteric  fever  which  are  met  with  in  country 
districts,  and  of  much  of  the  diarrhoea  which  becomes 
more  or  less  prevalent  during  dry  and  warm  seasons. 
Apart  from  overcrowding,  then,  it  may  be  said  that  the 
gravest  dangers  to  health  connected  with  the  dwellings 
of  the  poorer  classes  in  rural  and  small  urban  districts 
are  external  rather  than  internal,  and  therefore  it  is 
essential  that  in  making  a  systematic  inspection  of  such 


DWELLINGS.  251 

premises  special  attention  should  be  paid  to  the  surround- 
ings. The  points  to  be  noted  on  a  detailed  inspection 
are  the  following  : — Date  of  inspection  ;  name  or  situation 
of  house ;  name  of  owner  and  occupier ;  number  of  in- 
mates ;  number  of  lodgers,  if  any ;  number  of  living- 
rooms  and  sleeping -rooms  (if  overcrowding  is  suspected, 
the  cubic  space  of  the  sleeping -rooms  should  be  ascer- 
tained— see  Chapter  XVI.) ;  state  of  ventilation  (note 
whether  all  windows  are  made  to  open,  and  whether 
every  sleeping-room  not  provided  with  a  fire-place  has  a 
ventilating  opening  of  some  sort  in  addition  to  window) ; 
condition  of  floors  (whether  they  are  uneven  or  out  of 
repair) ;  condition  of  walls  (whether  damp  or  dilapidated) ; 
condition  of  roof  (whether  it  lets  in  the  wet) ;  general 
condition  of  premises  (whether  clean  and  in  good 
repair) ;  condition  of  drainage  (if  any  drain  enters  the 
house,  note  whether  it  is  properly  disconnected,  also  note 
whether  outside  drains  are  well  laid  and  properly  trapped) ; 
nature  of  water-supply  (if  from  a  well,  note  whether  there 
are  any  sources  of  pollution  near,  such  as  deep  ash-pit, 
privy,  cesspool  of  any  kind,  leaky  drain,  or  manure-pit — 
if  water  is  suspected,  have  it  analysed) ;  nature,  situation, 
and  condition  of  closet  accommodation  (note  whether 
closet  is  free  from  nuisance,  whether  there  is  a  deep  ash- 
pit in  connection  with  it,  whether,  if  not  a  pail-closet,  it 
is  situated  at  a  safe  distance  from  house  or  well,  etc.) ; 
other  nuisances  (such  as  keeping  of  pigs  too  near  dwell- 
ings, pig-wash  cisterns,  manure-heaps,  etc.) 

A  detailed  examination  of  all  these  various  items  is 
of  course  not  necessary  in  the  great  majority  of  cases,  but 
in  making  a  systematic  survey  of  a  district  it  is  essential 
that  they  should  be  noted  in  the  survey -book  (see 
Chapter  XVI.) 

With  regard  to  country  mansions  and  the  better 
class  country  houses,  the  dangers  to  health,  if  not  more 


252  DWELLINGS. 

numerous,  are  certainly  more  serious,  and  for  the  most 
part  are  connected  with  the  drainage  or  water-supply. 
Indeed,  it  is  no  exaggeration  to  say  that  grave  sanitary 
defects  will  be  found  to  exist  in  almost  every  country 
residence  which  has  not  been  built  or  inspected  within 
the  last  few  years ;  and  even  in  respect  to  new  buildings 
it  is  lamentable  to  find  that,  owing  to  ignorance  or 
neglect  on  the  part  of  architect,  contractor,  or  plumber, 
and  sometimes  of  all  three,  the  most  serious  blunders  are 
still  perpetrated. 

One  of  the  chief  dangers  in  country  houses  attaches 
to  the  cesspool  and  the  drains  leading  to  it.  The  cess- 
pool itself  is  generally  some  distance  from  the  house,  and 
is  provided  with  an  overflow  which  discharges  into  the 
nearest  ditch  or  brook.  It  is  rarely  ventilated,  but  is 
usually  completely  covered  up,  and  in  any  case  is  only 
cleaned  out  at  long  intervals,  sometimes  not  for  periods 
of  years.  The  drains  are  either  rubble  drains,  sometimes 
huge  brick  culverts,  or  common  tile  drains  ;  but,  whatever 
their  exact  structure,  they  permit  of  free  deposit,  and  are 
neither  efficiently  trapped  nor  ventilated.  In  close  prox- 
imity to  the  walls,  and  sometimes  under  the  floors,  there 
are  frequently  supplementary  cesspools  or  catch-pits,  in- 
tended to  retain  solid  matters,  which  are  kept  covered  up 
with  close-fitting  slabs,  and  are  so  seldom  opened  and 
cleaned  out  that  their  very  existence  becomes  forgotten. 
Into  this  system  of  drainage  are  discharged  directly  the 
pipes  from  sinks  and  sculleries,  the  overflow  pipes  from 
baths,  the  drains  from  cellars,  the  soil  pipes  from  water- 
closets,  and  very  often  the  rain-water  pipes. 

The  water-closets  are  generally  situated  somewhere  in 
the  centre  of  the  house,  badly  lighted,  badly  constructed, 
and  without  proper  ventilation.  The  soil-pipes  are  un- 
ventilated,  and  very  soon  become  decayed  and  perforated. 
Very  often  the  cistern  supplying  the  closet  is  filled  by 


DWELLINGS.  253 

means  of  a  force-pump ;  and  the  same  cistern,  which  is 
rarely  cleaned  out,  and  from  which  there  is  an  overflow- 
pipe  leading  direct  into  the  soil  pipe,  also  supplies  the 
water  for  drinking  and  cooking  purposes.  In  addition  to 
all  these  sources  of  danger,  the  well  itself  may  be  close 
to  one  of  these  leaky  drains  or  cesspools,  or  it  may  be 
near  some  outside  offices  of  the  worst  form  of  privy  or 
midden  ash-pit,  so  that  in  any  case  it  is  constantly  exposed 
to  the  risks  of  pollution. 

In  town  houses  of  old  construction  the  dangers  to 
health  are  similar,  though  perhaps  not  so  grave,  inasmuch 
as  the  water  used  for  domestic  purposes  is  usually  ob- 
tained from  a  public  supply.  But  even  this  may  become 
contaminated  in  the  house -cistern  if  the  overflow  pipe 
from  the  cistern,  as  often  happens,  discharges  directly 
into  the  soil-pipe  or  the  house-drain,  or  if  the  same  cistern 
directly  supplies  the  water-closet.  The  drains,  for  the 
most  part,  are  laid  underneath  the  house,  and  are  often 
found  to  be  constructed  of  brick,  and  generally  so  leaky 
that  the  sewage  percolates  into  the  soil.  In  houses  in- 
fested with  rats  it  may  be  taken  for  granted  that  the 
drains  are  brick  drains,  or  at  all  events  that  they  are  of 
very  faulty  construction.  Even  when  drain-pipes  have 
been  used,  they  are  frequently  so  badly  laid  and  jointed 
that  soakage  into  the  soil  becomes  constant,  and  the  inside 
air  of  the  house  always  more  or  less  contaminated.  The 
closets,  again,  are  generally  of  faulty  pattern,  and  very 
improperly  situated — it  may  be,  in  the  centre  of  the  house, 
on  the  landing,  or  sometimes  in  the  bedrooms  themselves  ; 
but  in  any  case  they  are  almost  always  badly  lighted  and 
ventilated.  The  soil-pipes,  as  in  country  houses,  are 
usually  inside  the  house,  often  very  leaky,  and  seldom 
ventilated,  nor  are  any  other  means  of  ventilation  pro- 
vided for  the  house-drains.  Moreover,  the  waste-pipes 
from  sinks,  baths,  and  cisterns  are  seldom  disconnected, 


254  DWELLINGS. 

so  that  channels  for  the  entrance  of  sewer-air  are  to  be 
found  on  every  floor  of  the  house,  but  especially  in  the 
basement,  where,  in  addition  to  the  leakiness  of  the  drains, 
there  are  openings  into  them  for  the  purpose  of  washing 
down  the  floors  or  draining  cellars.  These  drain  inlets 
are  a  permanent  source  of  danger,  because  the  traps  are 
often  bell-traps,  from  which  the  water  evaporates,  leaving 
practically  untrapped  openings ;  or  if  the  water  does  not 
evaporate,  the  pressure  of  sewer-gas  is  so  great  that  the 
water  becomes  saturated,  and  is  constantly  giving  off  foul 
emanations.  Sometimes  it  happens  that  foul  smells  are 
detected  in  parts  of  a  house  where  there  are  no  drains  or 
inside  pipes  discharging  into  them,  and  in  these  cases  it 
is  generally  found  that  the  foul  air  travels  along  rat  runs, 
under  floors,  or  behind  skirtings ;  or  it  may  be  conveyed 
along  the  pipes  containing  the  bell- wires ;  or  it  may  find 
an  entrance  through  the  windows,  from  an  adjacent  rain- 
water pipe  which  is  directly  connected  with  the  sewer. 
Of  course  foul  smells  in  a  house  do  not  always  indicate 
the  entrance  of  sewer-air,  but  they  should  never  be  tolerated 
a  single  day  until  the  cause  is  ascertained  and  removed. 
Sometimes  they  are  caused  by  the  decaying  body  of  a 
dead  rat  or  mouse  under  the  flooring,  by  dry  rot,  or,  in 
rare  instances,  they  have  been  found  to  proceed  from  some 
filthy  paste  used  in  papering  the  walls ;  but  as  a  rule 
they  point  to  defective  drainage  or  escape  of  sewer-gas 
into  some  part  of  the  house. 

3.  Mode  of  Inspection. — In  making  a  detailed  exami- 
nation of  the  sanitary  condition  of  a  house,  it  is  advisable 
that  either  an  experienced  builder,  whose  practical  know- 
ledge can  be  relied  upon,  or  a  sanitary  engineer,  be  called 
in ;  and  if  there  are  plans  of  the  house  and  drainage  in 
existence,  these  should  be  obtained.  In  order  to  make 
the  examination  as  thorough  as  possible,  arrangements 
should  be  made  to  have  the  drains  previously  opened  in 


DWELLINGS.  255 

several  places,  and  concealed  pipes  and  other  fittings  ex- 
posed to  view.  If  the  main  drain  is  found  to  pass  under 
the  house,  and  to  be  badly  laid  or  constructed,  the  instruc- 
tions should  be  to  have  it  taken  up  and  relaid.  Should 
it  appear  to  be  in  good  condition,  it  should  then  be  tested 
as  to  its  soundness,  which  is  done  by  stopping  it  up  at 
its  lower  end  and  filling  it  with  water,  and  noting  whether 
the  water  sinks  or  not,  and  at  what  rate.  To  test  whether 
there  are  any  deposits,  a  large  volume  of  water  should  be 
poured  down  at  the  water-closet  or  sink,  and  if  this 
appears  foul  and  thick  at  the  lower  opening  the  drain  is 
condemned  as  one  of  deposit.  By  noting  the  time  which 
intervenes  before  the  rush  of  water  appears  at  the  lower 
opening,  an  approximate  idea  may  be  obtained  of  the 
velocity  of  flow,  or  this  may  be  determined  with  greater 
precision  by  pouring  down  some  lime-water,  and  timing 
the  flow.  Leakages  in  the  pipe  tracks  or  elsewhere,  for  the 
escape  of  sewer -gas,  may  be  detected  by  pouring  down 
some  oil  of  peppermint  at  the  closet  or  sink,  or  blowing 
up  at  the  opening  made  in  the  drain  the  smoke  from 
burning  brown  paper. 

The  next  point  which  should  be  ascertained  is,  whether 
the  house  drain  is  disconnected ;  and  if  there  be  a  strong 
draught  up  the  drain  it  shows  that  there  is  no  intervening- 
trap.  As  already  shown  in  the  by-laws  laid  down  for 
the  drainage  of  new  houses,  this  disconnection  of  the 
house  drain  by  trapping,  and  providing  a  ventilating  open- 
ing on  the  house  side  of  the  trap,  is  of  the  utmost  im- 
portance, and  it  can  readily  be  carried  out  in  all  cases, 
either  by  providing  a  ventilating  pipe  if  the  house  is  close 
to  the  street,  or  a  simple  open  grating  if  there  is  sufficient 
space  (see  also  Chap.  XL) 

Before  leaving  the  basement,  all  traps  and  branch 
drains  should  be  carefully  examined,  and  a  careful  search 
should  be  made  for  cesspools,  if  the  existence  of  any  is 


256  DWELLINGS. 

suspected.  The  condition  of  the  flooring  should  also  be 
noted  as  to  dryness  or  otherwise,  and  the  ventilation  of 
all  parts  of  the  premises  should  be  inquired  into.  Any 
water-closet  on  the  basement  which  is  found  to  be  in  the 
centre  of  the  building,  or  to  abut  against  any  inside  wall, 
should  be  condemned.  Such  closets  are  badly  lighted 
and  ventilated,  and  the  drains  leading  from  them  are 
usually  very  defective,  and  liable  to  be  choked  up.  If 
there  are  no  underground  cellars  or  basement,  inquiry 
should  be  made  as  to  whether  the  space  beneath  the 
floors  is  sufficiently  ventilated,  and  whether  there  are  any 
signs  of  rot.  The  dust-bin  or  ash-pit,  and  any  outside 
offices,  should  also  be  examined,  and  if  the  ash-pit  is 
found  to  be  large  and  deep,  it  should  be  filled  up  to  the 
ground  level. 

The  details  to  which  attention  should  next  be  directed 
are  those  connected  with  water-closets,  sinks,  baths,  etc. 
If  the  closet  is  in  the  centre  of  the  house,  or  abuts  against 
an  inside  wall,  there  can  be  no  doubt  of  the  faultiness  of 
the  arrangement.  But  even  when  the  closet  abuts  against 
an  outer  wall  the  soil-pipe  generally  leads  down  inside 
the  house  into  the  drain,  and  not  infrequently  is  taken 
through  cupboards  or  larders.  The  track  of  the  pipe 
should  be  exposed  to  view,  and  its  soundness  tested,  by 
means  of  filling  it  with  water  or  by  the  smoke  test ;  but  it 
is  advisable  to  recommend,  in  any  case,  that  the  soil-pipe 
should  be  carried  outside,  and  be  ventilated  by  a  pipe  of 
the  same  dimensions  extending  to  above  the  eaves.  Small 
ventilating  pipes,  of  about  %  in.  or  li>  in.  in  diameter, 
are  practically  of  little  use,  and  often  become  choked  up. 
The  woodwork  and  fittings  of  the  closet  should  next  be 
examined,  and  auy  overflow-pipe  from  the  safe  should  be 
made  to  discharge  outside.  If  the  pipes  from  sinks,  lava- 
tories, and  baths  are  not  disconnected — and  it  is  seldom 
found  that  they  are,  except  it  be  in  new  houses — instruc- 


DWELLINGS.  257 

tions  should  be  given  to  have  all  these  pipes  carried  out- 
side the  walls  of  the  house,  and  made  to  discharge  on  to 
trapped  gratings  communicating  with  the  drain.  Kain- 
water  pipes  which  are  found  to  be  directly  connected 
with  the  drain  should  also  be  disconnected,  and  any 
found  passing  inside  the  house  should  be  carried  outside. 

The  cisterns  which  supply  the  closets  should  next  be 
examined,  and  it  should  be  ascertained  whether  these 
supply  the  drinking  water  as  well.  If  the  water  is  stored 
in  a  large  cistern  under  the  roof,  and  is  found  to  supply 
any  taps,  each  closet  supplied  from  this  cistern  should 
be  provided  with  a  small  waste-preventing  cistern,  or 
steps  should  be  taken  to  provide  an  independent  supply 
for  drinking  and  cooking  directly  from  the  main.  The 
cistern  itself  should  be  examined  as  to  cleanliness,  and 
the  overflow  pipe,  which  is  often  found  to  lead  directly 
into  the  soil-pipe,  should  be  carried  outside. 

In  all  houses  provided  with  a  public  supply,  the  use 
of  well  water  should  be  condemned,  because,  although  it 
may  be  found  to  be  fit  for  drinking  purposes,  the  risk  of 
pollution  is  always  greatly  increased  in  towns,  on  account 
of  neighbouring  drains  and  sewers.  In  country  districts 
special  attention  should  be  directed  to  the  water  supply, 
and  any  deep  ash-pits,  midden-privies,  or  cesspools  near 
wells  should  be  removed,  and  the  drains  examined.  If 
the  water  is  pumped  up  by  means  of  a  force-pump  into  a 
cistern,  for  the  purpose  of  supplying  the  closets,  it  will 
generally  be  found  that  the  cistern  also  supplies  the 
housemaid's  sink,  and  that  at  this  tap  the  water-bottles, 
as  well  as  bedroom  utensils,  are  usually  filled. 

With  regard  to  the  alterations  generally,  it  should 
be  recommended  that  unless  special  automatic  flushing 
arrangements  are  provided,  the  house  drains  should  have 
a  fall  of  at  least  one  in  thirty,  and  be  at  least  4  in.,  and 
never  more  than  6  in.,  in  diameter.  In  cases  where  a 

3 


258  DWELLINGS. 

proper  fall  cannot  be  obtained,  a  small  self-acting  flushing 
tank,  in  connection  with  the  sink,  should  be  provided. 
If  the  house  drains  extend  beyond  the  closets,  the  terminal 
end  should  be  ventilated,  as  well  as  the  soil-pipes,  and  no 
ventilating  pipe  should  be  less  than  4  in.  in  diameter. 
Manholes  should  be  placed  at  all  bends  in  the  drains  so 
as  to  permit  of  ready  inspection,  and  all  down  pipes 
should  either  be  exposed  to  view,  or,  if  encased,  the  casing 
should  be  made  easily  removable. 

Although  much  improvement  has  been  made  of  late 
years  in  the  sanitary  arrangements  of  dwellings,  it  should 
be  laid  down  as  a  rule  by  every  tenant  in  search  of  a 
house,  that  he  should  have  the  sanitary  condition  carefully 
inquired  into,  and  any  defects  removed,  before  he  takes 
possession.  In  London,  Edinburgh,  Gloucester,  and  several 
other  large  towns,  there  are  sanitary  protection  associa- 
tions which  undertake  such  inspections,  and  repeat  them 
at  stated  times  for  a  fixed  fee  or  subscription ;  but  it 
would  be  a  wise  policy  on  the  part  of  sanitary  authorities 
throughout  the  country  to  undertake  these  duties  them- 
selves, and  not  limit  their  functions  to  the  removal  of 
actual  nuisances,  without  interfering  with  many  defects 
which  only  become  declared  nuisances  when  disease 
breaks  out. 


HOSPITALS.  259 


CHAPTEE    X. 

HOSPITALS. 

IN  large  towns  the  position  of  every  hospital  must  prim- 
arily depend  on  the  distribution  of  the  population,  or 
part  of  the  population,  whose  wants  it  is  intended  to 
relieve,  and  hence  the  choice  with  regard  to  site  is  often 
very  limited.  Apart,  however,  from  this  restriction,  there 
are  certain  considerations  which  ought  always  to  influence 
the  selection  of  site.  For  example,  the  future  hospital 
should  be  erected  in  as  airy  and  open  a  space  as  can  be 
obtained,  preference  being  given  either  to  the  outskirts 
of  towns  or  to  their  largest  interior  unoccupied  spaces. 
According  to  the  recommendations  of  the  Chirurgical 
Society  of  Paris  in  1864,  a  free  area  of  not  less  than  540 
superficial  feet  should  be  allowed  for  each  patient.  This 
would  give  an  acre  of  ground  for  a  hospital  containing 
80  beds.  In  this  country,  on  the  other  hand,  an  acre  for 
100  patients  has  been  held  to  be  sufficient,  but  a  good 
deal  will  depend  on  the  size  of  the  hospital.  Any  defect 
in  salubrity  of  site  must  be  compensated  by  increased 
floor  and  cubic  space. 

No  doubt,  the  most  healthy  site  for  a  hospital  is  in 
the  open  country,  with  a  dry  and  porous  soil,  and  slightly 
raised  above  the  plain  to  facilitate  drainage,  but  even  a 
stiff  clayey  'soil  can  be  made  perfectly  healthy  if  proper 
precautions  be  taken  in  asphalting  or  concreting  the 
foundations,  and  in  providing  plenty  of  free  ventilation 


260  HOSPITALS. 

beneath  the  ground-floors.  While  shelter  from  the  cold 
north-easterly  winds  is  desirable,  it  is  an  error  to  build 
hospitals  on  the  face  of  a  steep  slope,  or  in  any  situation 
where  there  is  an  impediment  to  a  free  circulation  of  the 
air.  Undrained  marshy  ground  should  be  avoided,  nor 
should  houses  or  clumps  of  trees  be  in  close  proximity  to 
the  building. 

For  hospitals  situated  in  the  crowded  localities  of 
large  towns,  convalescent  homes  in  the  country,  or  at  the 
sea-side,  are  now  being  provided,  and  with  marked  advan- 
tage to  the  patients. 

The  late  discussions  on  hospitalism,  though  perhaps 
somewhat  one-sided  in  giving  such  prominence  to  the  test 
of  surgical  results,  have  fully  established  the  great  hygienic 
advantages  which  small  cottage  hospitals  possess  over  the 
large  palatial  buildings  that  have  hitherto  found  favour 
with  the  profession.  It  is  further  generally  admitted  that, 
when  large  hospitals  are  rendered  necessary,  they  should 
approximate  as  much  as  possible  to  the  sanitary  conditions 
which  can  only  be  ensured  by  small  detached  buildings. 
The  application  of  this  principle  has  resulted  in  the  con- 
struction of  hospitals  on  the  pavilion  system — a  system 
which  accommodates  itself  to  almost  any  site  and  to  any 
number  of  patients. 

SECTION  I. — PAVILION  HOSPITALS. 

In  this  description  of  hospital,  each  pavilion  may  be 
regarded  as  a  separate  hospital,  and  the  impurities  of 
every  single  ward  are  cut  off  from  the  other  wards.  The 
pavilions  are  united  by  a  corridor  for  administrative  pur- 
poses and  for  convenience,  but  are  so  arranged  that  a  free 
circulation  of  air  can  always  take  place  between  them. 
In  its  simplest  form  a  pavilion  would  consist  of  a  single 
ward,  with  the  necessary  additions  for  administration. 


HOSPITALS. 


261 


More  frequently,  however,  it  consists  of  two  wards,  one 
above  the  other,  and,  in  some  instances,  of  three  wards, 
as  in  the  Marine  Hospital  at  Woolwich.  Three-storied 
pavilions  are  objectionable,  because  their  height  necessi- 
tates a  lofty  corridor  to  unite  them,  and  induces  stagnation 
of  the  air.  With  two-storied  pavilions,  on  the  other  hand, 
the  corridor  need  only  be  half  the  height  of  the  pavilions. 


SCO 


Fig.  7.— General  Plan  of  Herbert  Hospital,  Woolwich. 
(From  "Construction  of  Hospitals,"  by  DOUGLAS  GALTON.) 

In  large  hospitals,  such  as  the  Herbert  Hospital,  the 
pavilions  may  be  united  in  twos,  end  to  end,  with  the 
corridor  running  between  them,  the  staircase  being,  as  it 


Fig.  8.— Sketch  of  the  end  of  the  southern  Pavilions  of  Herbert  Hospital, 
showing  the  elevation  of  the  Corridor.    (After  GALTOX.) 

were,  strung  on  to  the  corridor.     The   distance  between 
the  pavilions  should  be  at  least  twice  their  height. 


262  HOSPITALS. 

The  basis  or  unit  of  hospital  construction  is  the  ward. 
The  conditions  which  determine  the  size  and  form  of  a 
ward  are  the  following  : — 

1.  The  number  of  patients  which  it  should  contain. 

2.  The  floor  and  cubic  space  allowed  to  each  patient. 

3.  The  arrangements  for  warming,  light,  ventilation, 
and  nursing. 

1.  The  number  of  patients  in  a  ward  will  depend  on 
the  size  of  the  hospital,  and,  occasionally,  on  the  nature 
of  the  cases.     A  cottage  hospital,  for  example,  will  neces- 
sarily consist  of  small  wards,  and  even  in  large  hospitals 
small  wards  are  required  for  isolating  very  severe  or  special 
cases.     With  these  exceptions,  however,  the  number  of 
patients  in  a  ward  must  depend  mainly  upon  the  number 
which  can  be  efficiently  nursed  at  the  smallest  cost  per 
head.     Miss  Nightingale,  in  the  Eeport  on  Metropolitan 
Workhouses,  fixes  this  number  at  32.     She  says,  "  A  head 
nurse  can  efficiently  supervise,  a  night  nurse  can  carefully 
watch,  3  2   beds  in  one  ward ;  whereas,  with  3  2  beds  in 
four  wards,  it  is  quite  impossible."     Throughout  European 
hospitals  the  number  varies  from  24  to  32. 

2.  One  of  the  most  important  questions  attaching  to 
hospital  construction  is  the   amount  of  floor  and  cubic 
space  which  should  be  allowed  to  each  patient,  and  there 
is  scarcely  any  question  concerning  which  there  has  been 
so  much  discrepancy  of  opinion.     Thus,  Dr.  Todd  main- 
tained that  500  cubic  feet  were  sufficient ;  Dr.  Burrows, 
1000;  the  Army  Sanitary  Commission,  1200;  and  the 
Committee  appointed  to  consider  the  cubic  space  of  Metro- 
politan Workhouses,  850.     The  recommendations  of  this 
Committee  further  limited  the  cubic  space  allowance  for 
dormitories  to  a  minimum  of  3  0  0  feet,  and  for  wards  con- 
taining infirm  paupers  to  a  minimum  of  500  feet  per  head. 
There  is  no  doubt,  however,  that,  in  consequence  of  the 
conflicting  evidence  on  which  the  Committee  had  to  base 


HOSPITALS.  263 

• 

its  recommendations,  the  difficulties  of  efficiently  ventilat- 
ing small  spaces  without  draught  were  not  sufficiently 
appreciated ;  but  as  reference  has  already  been  made  with 
regard  to  this  point,  it  need  not  be  again  discussed.  Suffice 
it  to  say  that  General  Morin,  the  greatest  French  authority 
on  ventilation,  to  whom  the  disputed  subject  was  sub- 
mitted, gave  it  as  his  opinion  that,  even  for  paupers  who 
are  not  ill,  he  considered  it  "  necessary  not  to  descend 
below  880  cubic  feet  of  space,  and  besides  this  the  con- 
dition must  be  imposed  of  renewing  the  air  in  the  pro- 
portion of  1060  cubic  feet  per  individual  per  hour." 

For  ordinary  hospital  cases  it  is  now  generally  admitted 
that  a  cubic  space  of  at  least  1200  feet  should  be  allowed 
per  patient,  and  for  cases  of  infectious  disease,  or  for  severe 
surgical  cases,  as  much  as  2000,  and  it  may  be  doubted  if 
this  be  sufficient  at  all  times. 

On  the  superficial  area  per  bed  will  depend  the  dis- 
tance between  the  beds,  the  facilities  for  nursing,  and  the 
conveniences  for  ward  administration.  This,  like  the  cubic 
space,  has  been  variously  estimated.  Thus,  in  St.  George's 
Hospital  it  is  only  6  9  square  feet ;  in  St.  Bartholomew's 
it  is  79;  in  the  Herbert  Hospital,  99  ;  in  the  Netley 
Hospital,  1 0  3  ;  in  Guy's,  138;  and  in  the  new  St.  Thomas's 
Hospital,  112.  For  all  nursing  purposes,  Miss  Nightin- 
gale maintains  that  at  least  90  square  feet  should  be 
allowed  per  bed,  and  this  amount,  according  to  Captain 
Gal  ton,  should  be  accepted  as  a  minimum.  Where  medi- 
cal schools  are  attached  to  hospitals,  an  extra  allowance 
must  be  allotted  for  the  requirements  of  clinical  teaching. 
The  space  must  also  be  greatly  increased  in  fever  or  lying- 
in  wards.  The  height  of  an  average-sized  ward  should  be 
13  or  14  feet. 

3.  For  providing  sufficient  light  and  for  maintaining 
purity  of  the  air,  much  depends  on  the  width  of  the  ward. 
Experience  has  shown  that  this  should  not  be  less  than 


264  HOSPITALS. 

24  feet,  and  not  more  than  30  or  35.  In  the  new.  Leeds 
Hospital  it  is  27  feet  6  inches ;  in  the  new  St.  Thomas's 
28  feet;  and  in  the  Herbert  Hospital  26. 

The  ventilation  of  each  ward  should  be  entirely  in- 
dependent of  the  others,  and  to  effect  this,  cross-ventilation 
by  means  of  open  windows,  aided  by  Sheringham  valves, 
extraction  flues,  and  ventilating  fire-places,  is  deemed  to 
be  the  most  efficient.  In  the  summer  months,  when  fires 
are  not  required,  the  windows  should  always  be  kept  more 
or  less  open,  except  during  rough,  blustering  weather. 

When  a  window  is  allowed  for  each  bed,  which  is 
sometimes  the  case,  the  wall-space  between  the  windows 
should  be  six  or  eight  inches  wider  than  the  bed.  In  the 
pavilion  system,  however,  an  allowance  of  one  window  for 
every  two  beds  is  generally  considered  sufficient,  the  beds 
being  arranged  in  pairs  between  the  windows,  and  sepa- 
rated from  each  other  by  a  distance  of  at  least  three  feet. 
The  windows  should  reach  from  within  two  feet  or  two 
feet  six  inches  from  the  floor  to  within  one  foot  from  the 
ceiling.  The  space  between  the  end  wall  and  the  first 
window  on  either  side  of  the  ward  should  be  four  feet  six 
inches,  and  the  space  between  the  adjacent  windows  nine 
feet,  the  windows  themselves  being  four  feet  six  inches 
wide.  An  end  window  to  a  long  ward  adds  greatly  to 
its  cheerfulness,  and  aids  materially  in  the  ventilation  of 
the  ward.  The  ordinary  sash  window,  made  to  open  at 
top  and  bottom,  is  perhaps  preferable  to  any  other  kind. 
To  economise  heat,  plate-glass  should  be  used  instead  of 
ordinary  glass. 

In  addition  to  means  of  ventilation  provided  by  win- 
dows, there  should  be  a  fresh -air  inlet,  furnished  with  a 
Sheringham  valve,  placed  near  the  ceiling  and  between 
each  window,  or  an  upright  ventilating  tube  of  the  kind 
recommended  by  Mr.  Tobin.  When  the  fire-places  are 
situated  in  the  external  walls,  two  or  three  fresh-air  inlets 


HOSPITALS.  265 

may  be  provided  at  equal  distances  along  the  centre  of 
the  floor,  and  communicating  by  means  of  transverse  flues 
beneath  the  flooring  with  the  external  air.  Such  inlets 
are  so  far  removed  from  the  beds  that  the  currents  enter- 
ing through  them  are  not  felt  by  the  patients  when  in 
bed,  and  they  could  be  closed  if  deemed  necessary  during 
the  day-time.  The  gratings  covering  them  should  be 
capable  of  easy  removal,  so  that  the  flues  may  be  cleaned 
out  regularly. 

The  extraction  flues  should  be  situated,  if  possible,  on 
the  same  side  of  the  ward  as  the  fire-places,  and  should 
be  carried  above  the  roof  and  louvred.  When  not  con- 
tiguous with  a  chimney,  they  should  be  provided  with 
gas-jets  to  aid  their  extractive  power.  If  the  fire-places 
are  situated  in  the  centre  of  the  ward,  the  extraction-flues 
should  be  placed  in  the  opposite  corners.  The  inlets  to 
extraction-flues  ought  to  be  near  the  ceiling,  but  not  in 
close  proximity  to  the  fresh-air  inlets. 

The  fire-places  best  suited  for  infirmary  wards  are  the 
ventilating  stoves  already  described  in  the  Chapter  on 
Ventilation.  But  in  addition  to  these,  or  in  place  of 
them,  the  fresh  air  might  also  be  heated  by  hot-water 
pipes,  coiled  in  boxes  below  each  bed,  as  recommended 
by  Dr.  Parkes,  or  the  pipes  might  pass  along  behind  the 
skirting,  the  skirting  being  perforated  or  supplied  with 
k^atings  opposite  each  bed  for  the  admission  of  the  heated 
air. 

Every  gas-jet  in  a  ward  should  be  furnished  with  a 
bottomless  lantern,  communicating  with  an  extraction-tube, 
to  carry  off  the  products  of  combustion,  or  Eickett's  ven- 
tilating globe  lights  should  be  used.  (For  particulars  with 
regard  to  ventilation,  see  Chapter  on  that  subject.) 

The  furniture  in  a  ward  ought  always  to  be  reduced 
to  a  minimum,  and  should  never  be  cumbrous  or  bulky. 
Iron  bedsteads  are  to  be  preferred  to  wooden  ones,  and 


266  HOSPITALS. 

thin  horse-hair  mattresses,  placed  on  springs,  or  on  woven 
wire  mattresses,  to  thick  flock  or  woollen  mattresses.  All 
bedsteads  should  be  ranged  at  a  short  distance  from  the 
walls.  Coverlets  and  blankets  should  be  white  or  light- 
coloured,  to  show  dirt,  and  ought  to  be  frequently  aired. 

The  other  points  of  sanitary  importance  connected 
with  a  ward  are  its  offices,  and  the  materials  employed  in 
construction. 

Ward-offices  are  required  for  facilitating  nursing,  and 
for  the  direct  use  of  the  sick.  Thus  every  ward  should 
have  attached  to  it,  at  the  end  nearest  the  door,  a  scullery 
and  a  nurse's  room,  and,  at  the  farther  end  a  water-closet 
and  ablution -room.  The  nurse's  room  should  be  light 
and  airy,  and  large  enough  to  be  used  as  a  bedroom.  It 
should  also  be  provided  with  a  window,  looking  into  the 
ward,  for  purposes  of  inspection.  The  scullery  should 
be  situated  opposite  the  nurse's  room,  and  ought  to  be 
fitted  with  a  small  range  for  warming  drinks,  preparing 
fomentations,  etc.;  a  sink  with  hot  and  cold  water  laid 
on ;  and  shelves  and  racks  for  dishes.  It  should  be  large 
enough  for  the  assistant  nurses  to  take  their  meals  in. 

The  water-closet  and  ablution-room  should  be  situated, 


w 


Fig.  9.    (After  GALTON.) 

one  at  either  farther  corner  of  the  ward,  and  both  should 
be  completely  cut  off  by  means  of  swing-doors  and  a 
lobby  supplied  with  cross-ventilation  from  the  ward.  The 
water-closet  apartment  ought  to  contain  one  closet  for 


HOSPITALS.  267 

every  10  beds,  or  3  closets  for  32,  and  should  also  be 
supplied  with  a  sink  and  a  urinal.  Instead  of  a  handle 
and  plug  for  turning  on  the  water  for  flushing,  it  is  pre- 
ferable to  have  a  self-acting  water-supply  connected  with 
the  door,  because  some  patients  are  careless,  and  others 
are  too  feeble  to  raise  the  handle. 

The  ablution-room  should  contain  a  plunge-bath  with 
hot  and  cold  water  laid  on,  a  shower-bath  overhanging  the 
broad  end  of  the  plunge-bath,  and  a  lavatory  table  fitted 
with  basins,  and  also  supplied  with  hot  and  cold  water. 
There  should  likewise  be  room  enough  to  contain  a  port- 
able bath  on  wheels,  a  hip-bath,  and  a  foot-bath  for  the 
use  of  patients  more  or  less  bed-ridden.  The  pipes  lead- 
ing from  the  sink  and  lavatory  table  should  not  be  boxed 
in,  because  the  spaces  thus  enclosed  become  receptacles 
for  dirt. 

The  supply  of  water  should  be  ample,  and  the  drain- 
age and  sewerage  perfect.  All  closet  pipes  should  be 
ventilated  and  placed  against  outside  walls,  and  all  other 
pipes  disconnected  from  the  drains.  The  various  fittings 
should  be  of  a  light  colour,  to  show  dirt,  and  thus  ensure 
thorough  cleanliness.  The  walls  of  closets  and  ablution- 
rooms  should  be  lined  with  Parian  cement,  glazed  tiles,  or 
enamelled  slate. 

With  regard  to-  the  materials  of  ward  construction,  it 
is  now  strongly  recommended  that  floors  should  be  made 
of  hard  wood,  such  as  oak  laid  on  concrete  and  well 
jointed ;  that  the  walls  should  be  lined  with  Parian 
cement,  or  well  plastered,  periodically  cleaned,  and  white- 
washed or  painted ;  and  that  the  ceilings  should  be  plas- 
tered and  whitewashed,  or  painted  a  light  colour.  Floors 
of  upper  wards  ought  to  be  non-conductive  of  sound. 

A  ward  thus  constructed  and  arranged  is  in  itself  a 
small  hospital,  and  the  aggregation  of  ward  units  will 
depend  on  the  number  of  patients  to  be  accommodated. 


268  HOSPITALS. 

In  an  average-sized  hospital  the  administrative  build- 
ings occupy  considerable  space,  and  may  be  variously  dis- 
tributed. All  of  them,  however,  must  be  made  entirely 
subservient  to  the  requirements  of  the  sick,  and  should 
not  interfere  with  the  ventilation  of  the  wards.  Usually 
the  administrative  buildings  are  as  follows : — 

Kitchen,  provision-stores,  and  stores  for  bedding  and 
linen.  These  should  be  central. 

Apartments  for  house-surgeon,  matron,  and  servants ; 
consulting-room,  waiting-room,  surgery,  drug-store,  and 
operating-room ;  all  of  them  more  or  less  central. 

Laundry,  mortuary,  post-mortem  room,  disinfecting- 
room.  These  should  all  be  detached  from  the  building. 

The  night-nurses  should  have  well -ventilated  bed- 
rooms at  a  distance  from  the  wards,  with  all  the  necessary 
appliances  for  ablution,  etc. 

The  staircases  for  patients  should  be  broad  and  easy, 
and  should  be  cut  off  from  the  connecting  corridors  by 
swing-doors.  The  corridors  themselves  should  be  as  low 
as  possible,  well  lighted,  warmed,  and  ventilated. 

According    to    Captain    Galton,    the    administrative 


Fig.  10.— General  Plan  of  Swansea  New  Hospital. 

A,  Administration  ;  B,  Men's  Wards  ;  C,  Women's  Wards  and  Out-patients  ; 
D,  Operating  Room  and  Eye  Ward.    (After  GALTON.) 

buildings  take  up  about  half  the  cubic  space  of  the  whole 
hospital.     As  very  good  examples  of  the  pavilion  form  of 


HOSPITALS.  269 

hospital  on  the  small  scale,  he  instances  the  Eoyal  Hants 
County  Hospital  at  Winchester,  the  Buckinghamshire 
County  Hospital  at  Aylesbury,  and  the  New  Hospital  at 
Swansea. 

With  regard  to  the  cost  of  pavilion  hospitals,  Captain 
Galton  is  of  opinion  that,  with  care  and  attention  to 
economy  in  the  design,  a  hospital  for  in-patients  only,  and 
built  on  a  favourable  site,  should  not  cost  more  than  from 
£90  to  £120  per  bed.  The  Leeds  Hospital,  which 
accommodates  350  patients,  cost  £197  per  bed;  the 
Eoyal  Hants  Hospital,  with  108  beds,  and  including 
accommodation  for  out-patients,  cost  £229  ;  and  the 
Swansea  Hospital,  also  including  an  outside-patient  de- 
partment, cost  £142  per  bed. 

Day-wards,  exercising  grounds,  and  flower  or  winter 
gardens,  are  great  additions  to  the  sanitary  advantages 
supplied  by  a  well-constructed  hospital.  In  summer,  all 
the  patients  who  are  able  to  move  about,  and,  indeed, 
most  of  those  who  are  bed-ridden,  should  be  allowed  to 
remain  during  some  part  of  every  warm  day  in  the  open 
air.  The  flat  roofs  of  the  corridors,  protected  by  awnings, 
could  be  utilised  for  the  bed-ridden  patients  of  the  upper 
wards,  while  the  corridors  themselves  might  be  appropri- 
ated by  the  same  class  of  patients  belonging  to  the  lower 
wards.  With  very  little  extra  expense  the  corridors 
could  be  converted  into  winter  gardens. during  the  colder 
months  of  the  year,  and  might  be  occupied  by  patients 
in  the  day-time  without  interfering  with  any  of  the  ad- 
ministrative arrangements. 


SECTION  II. — COTTAGE  HOSPITALS. 

The  cottage  hospital  system,  originated  by  Mr.  Napper 
of   Cranleigh,   is   based   on   the   principles    of  providing 


270  HOSPITALS. 

hospital  accommodation  for  the  sick  poor  of  rural  districts, 
with  as  much  of  the  surroundings  of  home  as  possible ; 
of  permitting  equality  of  privilege  to  subscribers  in  recom- 
mending patients,  the  patients  themselves  paying  a  certain 
sum  weekly,  according  to  their  means;  and  of  allowing 
any  medical  man  practising  in  the  district  the  use  of  the 
hospital  for  deserving  cases  under  his  care.  The  model 
cottage  hospital  should  not  have  more  than  twenty  beds, 
and  must  be  under  the  management  of  one  medical  man 
as  director,  appointed  either  permanently  or  by  rotation, 
the  other  medical  men  in  the  district  holding  office  as 
honorary  medical  officers.  The  annual  cost  of  the  estab- 
lishment is  defrayed  chiefly  by  voluntary  contributions 
and  partly  by  the  weekly  payments  of  the  patients. 
These  weekly  payments,  as  already  stated,  are  regulated 
by  the  means  of  the  patient,  and  vary  from  2s.  6d.  when 
the  Union  has  to  help,  to  5s.  or  8s.  when  the  patient  has 
been  earning  fair  wages,  or  belongs  to  a  club.  All  fees 
allowed  by  the  Union  for  accidents  or  operations  are  paid 
to  the  Union  medical  officer,  in  the  same  way  as  if  he  had 
attended  the  patient  at  his  own  home.  Every  subscriber, 
no  matter  what  the  amount  of  his  subscription,  should 
have  equal  privileges  in  recommending  cases,  and  will 
generally  be  able  to  state  what  amount  the  patient  whom 
he  recommends  can  afford  to  contribute  weekly.  Cases 
of  accident  and  emergency  are  admitted  without  order,  but 
otherwise  a  recommendation  from  a  subscriber  must  be 
procured,  and  this  should  in  all  instances  be  accompanied 
by  a  certificate  from  one  of  the  medical  staff,  to  the  effect 
that  the  case  is  one  deserving  and  fit  for  admission. 
Only  those  are  admitted  who  cannot  be  efficiently  treated 
at  their  own  homes,  while  cases  of  infectious  or  incurable 
disease  are  excluded.  In  some  few  hospitals  pay  patients 
are  admitted  where  there  is  sufficient  accommodation,  and 
it  is  rightly  urged  by  Mr.  Burdett  in  his  excellent  work 


"HOSPITALS.  2*71 

on  Cottage  Hospitals  that  this  system  should  be  extended 
to  all  hospitals. 

Experience  has  proved  that  in  rural  districts  a  cottage 
hospital  of  six  beds  will  suffice  for  a  population  of  6000. 
The  initial  outlay  will  of  course  depend  on  whether  a 
cottage  which  has  already  been  built  can  be  procured, 
and,  if  so,  what  alterations  will  be  necessary  to  convert  it 
into  a  hospital.  If  the  hospital  has  to  be  built,  the  amount 
required  may  be  estimated  at  £600,  or  about  £100  per 
bed.  In  converting  a  cottage  which  has  already  been 
occupied  into  a  hospital,  the  walls  should  be  thoroughly, 
cleaned,  scraped,  and  afterwards  re-plastered  and  washed 
with  caustic  lime.  Attention  must  also  be  paid  to  the 
sanitary  surroundings  of  the  building. 

The  cost  of  furnishing  a  cottage  hospital  for  six  beds 
will  amount  to  about  £100,  and  the  necessary  surgical 
instruments  to  about  £50.  The  maintenance  per  patient 
weekly  would  cost  from  10s.  to  15s.,  so  that  the  hospital, 
when  once  started  and  properly  furnished,  will  require  for 
its  support  an  annual  income  of  at  least  £150,  about  £25 
or  £30  of  which  will  be  subscribed  by  patients. 

Although  the  architectural  arrangements  may  admit 
of  many  variations,  the  plan  best  suited  for  a  cottage 
hospital  of  six  beds  should  provide  for  a  nurse's  room,  a 
three-bedded  male  ward,  a  two-bedded  female  ward,  a 
single-bedded  ward,  which  can  be  used  as  an  operation 
room,  a  kitchen,  which  may  also  be  used  as  a  day -ward, 
a  scullery,  and  a  small  mortuary.  All  the  rooms  should, 
if  possible,  be  on  the  ground-floor,  so  that  good  roof  venti- 
lation and  ample  cubic  space  may  be  secured.  Part  of 
the  roof  should  overhang,  so  as  to  form  a  sort  of  verandah 
for  the  use  of  patients.  It  need  scarcely  be  added  that 
a  tasteful  arrangement  of  flowers  and  shrubs  in  the  space 
immediately  surrounding  the  hospital  will  add  greatly  to 
its  cheerfulness. 


272  HOSPITALS. 

As  regards  nursing,  cooking,  and  management,  much 
will  depend  on  the  size  of  the  hospital,  but  efforts 
should  always  be  made  to  secure  the  services  of  a  trained 
nurse. 

If  a  cesspool  is  used  as  the  receptacle  of  excreta,  it 
should  be  at  a  safe  distance  from  the  building,  and  con- 
structed as  described  in  the  Chapter  on  Dwellings ;  but 
where  no  water  is  laid  on,  the  pail  or  dry-earth  system  is 
to  be  preferred. — (See  Handy  Book  of  Cottage  Hospitals, 
by  Dr.  Swete,  and  the  much  more  exhaustive  work,  Cottage 
Hospitals,  by  Mr.  Burdett.) 

SECTION  III. — HOSPITALS  FOR  CASES  OF 
INFECTIOUS  DISEASE. 

By  the  131st  clause  of  the  Public  Health  Act,  1875, 
power  is  given  to  the  sanitary  authorities  of  any  town 
or  district  to  provide,  for  the  use  of  the  inhabitants, 
"  hospitals  or  temporary  places  for  the  reception  of  the 
sick;"  and  when  such  provision  has  been  made,  any 
Justice  may  order  the  removal  to  the  hospital  of  any 
person  suffering  from  a  dangerous  infectious  disease  who 
is  without  proper  lodging,  or  lodged  in  a  room  containing 
more  than  one  family,  or  is  on  board  ship.  Judging  from 
my  own  experience,  however,  and  that  of  other  health 
officers,  it  is  very  seldom  that  a  magistrate's  order  is  re- 
quired for  the  removal  of  a  patient,  inasmuch  as  patients 
and  their  friends  are,  as  a  rule,  only  too  glad  to  avail 
themselves  of  the  advantages  of  a  hospital  of  the  kind, 
when  proper  isolation  and  adequate  nursing  cannot  be 
procured  at  their  own  homes. 

In  a  Memorandum  of  the  Privy  Council,  printed  in 
the  Appendix  to  the  First  Eeport  of  the  Local  Govern- 
ment Board,  it  is  recommended,  as  a  condition  of  the 
first  importance,  that  the  accommodation  for  isolating 


HOSPITALS.  273 

cases  of  infectious  disease  shall  be  ready  beforehand ; 
and  further,  that  it  shall  be  sufficient  for  the  treatment 
of  different  infectious  diseases  separately.  The  amount 
of  accommodation  required  will  of  course  vary  for 
different  places.  As  regards  villages,  for  example,  it  is 
recommended  that  "each  village  ought  to  have  the 
means  of  accommodating  instantly,  or  at  a  few  hours' 
notice,  say  four  cases  of  infectious  disease,  in  at  least 
two  separate  rooms,  without  requiring  their  removal  to  a 
distance.  A  decent  four-room  or  six-room  cottage,  at 
the  disposal  of  the  authority,  would  answer  the  purpose. 
Or  permanent  arrangement  might  be  made  beforehand 
with  trustworthy  cottage  -  holders  not  having  children, 
to  receive  and  nurse,  in  case  of  need,  patients  requiring 
such  accommodation.  Two  small  adjacent  villages  (if 
under  the  same  Sanitary  Authority)  might  often  be  re- 
garded as  one." 

If  further  accommodation  be  at  any  time  required, 
neighbouring  cottages  should  be  hired,  or  tents  or  huts 
may  be  erected  on  adjacent  ground. 

Practically,  however,  it  is  found  that  Sanitary 
Authorities  are  generally  so  averse  to  providing  any 
accommodation  of  the  kind,  unless  under  the  stern 
pressure  of  an  epidemic,  that  in  rural  districts,  especi- 
ally, the  health  officer  may  consider  himself  fortunate 
if  he  succeeds  in  obtaining  a  place  sufficiently  central  to 
meet  the  requirements  of  a  whole  union,  or  at  least  the 
most  populous  parts  of  it.  With  a  good  ambulance, 
patients,  if  fit  to  be  moved  at  all,  can,  I  believe,  be 
moved  a  distance  of  about  six  or  eight  miles  without 
risk.  In  reference  to  this  point,  Dr.  Thome,  in  his 
exhaustive  report  on  Infectious  Hospitals,  says  : — "  It  is 
not  that  removal  for  a  distance  of  some  five,  and  even  in 
isolated  instances,  eight  and  ten  miles  in  a  well-con- 
structed ambulance,  and  over  ordinarily  good  roads,  has 

T 


274  HOSPITALS. 

appeared  to  do  harm  to  the  particular  patient,  provided 
the  removal  has  heen  effected  at  an  early  stage  of  the 
disease.  By  far  the  greatest  difficulty  in  the  matter  of 
distance  has  been  found,  as  a  rule,  to  lie  with  the  relatives 
and  friends  of  the  patients,  who  assent  much  more  readily 
to  removal  to  hospital  if  it  be  within  such  distance  as  to 
enable  them,  without  much  trouble  and  without  material 
interference  with  their  business  and  other  avocations,  to 
make  frequent  inquiry  as  to  the  patient's  welfare.  In 
rural  districts,  the  question  of  distance  is  usually  less 
thought  of  than  in  urban  districts,  especially  when  the 
hospital  to  which  removal  is  effected  is  in  or  near  some 
centre  to  which  the  population  often  travel  in  connection 
with  their  daily  or  occasional  pursuits."  Then,  too,  it  was 
found  in  the  course  of  Dr.  Thome's  inquiry,  that  strong 
objection  was  often  raised  to  the  removal  of  patients  from 
one  district  to  another,  as  from  rural  districts  in  the 
neighbourhood  of  large  towns  to  hospitals  situated  in  those 
towns,  even  when  arrangements  had  been  made  between 
the  Sanitary  Authorities  for  the  reception  of  patients  from 
adjoining  districts. — (See  Tenth,  Annual  Report  of  the 
Local  Government  Board,  1882.) 

The  question  here  arises,  and  it  is  a  somewhat 
difficult  one  to  answer,  What  should  be  the  ratio  of  beds 
to  the  population  for  whose  wants  the  hospital  is  to  be 
provided  ?  Dr.  Buchanan,  in  a  very  able  address 
delivered  in  1876  to  the  Medical  Society  of  London, 
lays  down  the  ratio  of  one  bed  to  every  1000  inhabit- 
ants, and  no  doubt,  taking  this  as  an  average  estimate, 
it  may  be  considered  as  fairly  accurate.  But  much  will 
depend  upon  the  special  circumstances  of  the  district  and 
population.  For  example,  a  poor  crowded  district  will 
require  a  larger  amount  of  accommodation  than  a  district 
not  crowded,  and  whose  inhabitants  are  on  the  whole 
well  off.  In  the  latter  case,  the  ratio  of  one  bed  to 


HOSPITALS.  2*75 

every  2000  inhabitants,  with  means  for  temporary  ex- 
tension, if  it  should  be  required,  might  be  considered 
sufficient. 

It  heed  hardly  be  said  that  the  greatest  difficulty 'is 
frequently  experiened  in  obtaining  a  site.  Vested  in- 
terests at  once  take  alarm  because  the  popular  prejudice 
against  living  in  the  vicinity  of  such  hospitals  is  so  great 
that  property  will,  for  the  time  being,  depreciate  in  value. 
The  site,  therefore,  which  may  be  ultimately  fixed  upon 
may  not  be  free  from  objection,  but  it  should  always  be 
such  that  no  sanitary  objection  can  be  raised  against  it. 
If  the  soil  is  stiff  and  clayey,  special  care  ought  to  be  taken, 
by  means  of  drainage,  a  free  use  of  concrete  or  asphalt, 
and  abundant  ventilation,  to  secure  perfect  dryness  of  the 
building.  The  building  itself  should  be  sufficiently  central 
as  regards  the  distribution  of  the  population  of  the  district, 
sufficiently  accessible  from  all  parts  of  the  district,  and, 
if  possible,  well  isolated.  In  rural  or  suburban  districts, 
there  ought  to  be  no  difficulty  in  obtaining  an  abundant 
supply  of  good  water,  nor  any  difficulty  in  getting  rid  of 
the  excremental  matters  and  slops. 

The  question  of  cost  of  site  will  of  course  vary  im- 
mensely according  to  the  circumstances  of  the  district, 
while  the  amount  of  space  required  will  also  vary  very 
much.  But,  speaking  roughly,  no  site  to  afford  sufficient 
isolation  should  be  less  than  one  acre  in  extent,  and  a 
hospital,  say  of  thirty  beds,  would  require  about  two 
acres.  Then,  too,  the  site  should  be  surrounded  by  a 
suitable  fence  to  cut  off  all  communication  except  through 
the  lodge  entrance,  and  such  fence  Dr.  Thorne  recom- 
mends should  be  a  wall  about  6  feet  6  inches  high. 
The  following  table  from  Dr.  Thome's  report  gives  im- 
portant particulars  with  regard  to  the  best  arranged 
permanent  hospitals  which  he  visited : — 


276 


HOSPITALS. 


I 

IJ 

1 

i|g 

II. 

fcl 

31 

|1. 

c3  +^ 

o 

^3    *—  '  -*° 

rt  ^Q  QJ 

c8  ^  ^ 

C3  *t2 

t-t  £?;£« 

5 

••§!, 

1 

g  §5-3 
8  °<& 

?.S£ 

1"! 

O   &   O 

4^    0  'S 

SI 

a 
5 

£ 

Efl 

P 

Ita 

Is 

il 

Berkhampstead, 
rural 

11,000 

8 

07 

144 

2000 

£ 
2,162 

£ 
270 

Cheltenham, 

urban    . 

44,000 

32 

07 

Varies  ; 

Varies  ; 

11,121 

347 

mean  is  144 

mean  is  2300 

Darlington, 
urban    . 

35,000 

44 

1-3 

144  to  175 

2000 

10,123 

225 

Folkstone,  urban 

18,700 

14 

07 

140  1 

2000 

2,800 

200 

Lewes,  combined 

districts 

11,200 

12 

1-1 

144 

2000 

1,975 

164 

Middlesborough, 

i 

urban    . 

56,000 

32 

0-6 

122  to  180 

1620  to  2100 

6,829 

213 

Sheffield,  urban 

285,000 

64 

0-2 

138 

1810 

19,785 

309 

Solihull,  rural  . 

20,000 

12 

0-6 

144  to  156 

2000  to  2184 

2,892 

241 

Tonbridge, 

urban    . 

10,000 

12 

1-2 

140 

2000 

1,394 

116 

Warrington, 

urban    . 

42,000 

28 

07 

144  to  175 

2058  to  2529 

6,555 

234 

"Weymouth,  port 

? 

26 

? 

144  to  169 

2014  to  2028 

5,135 

192 

Permanent  hospitals  should  be  built  of  brick  or  stone, 
and  not  of  wood  or  corrugated  iron,  because,  apart  from 
other  reasons,  it  was  found  in  the  course  of  Dr.  Thome's 
inquiry  that  it  was  very  difficult  to  maintain  in  the  latter 
class  of  buildings  a  sufficiently  warm  temperature  in  cold 
weather.  They  should  be  built  on  the  pavilion  system, 
and  consist  of  an  administrative  block;  at  least  four  wards, 
in  two  separate  pairs,  in  which  patients  of  both  sexes, 
suffering  from  two  different  infectious  fevers,  can  be 


HOSPITALS.  27*7 

simultaneously  treated ;  and  certain  outbuildings,  such  as 
mortuary,  laundry,  etc. 

The  administrative  block  is  usually  built  in  excess  of 
the  requirements  of  the  permanent  pavilions,  so  as  to  be 
commodious  enough  for  any  future  extensions,  should  they 
become  necessary ;  and  where  it  is  desirable  to  economise 
space,  it  may  be  a  two-storied  building.  It  should  only 
communicate  with  the  pavilions  by  means  of  covered 
passages  with  free  cross-ventilation ;  and  should  be  so 
situated  that  persons  can  enter  it  without  passing  close 
to  the  pavilions. 

The  pavilions  themselves  are  generally  one-storied 
buildings,  but  where  a  site  is  necessarily  limited  Dr.  Thorne 
saw  no  reason  to  object  to  two-storied  pavilions,  provided 
of  course  that  only  patients  suffering  from  one  kind  of 
infectious  disease  are  treated  in  the  same  pavilion — the 
patients  of  one  sex  on  one  floor,  and  the  patients  of  the 
other  sex  on  the  other  floor.  The  distance  between  the 
several  pavilions  and  between  them  and  the  administrative 
block  should  be  equal  to  one  and  a  half  times  their  height, 
and  when  the  buildings  are  of  unequal  height,  it  should 
at  least  be  equal  to  the  full  height  of  the  higher  of  the 
adjacent  buildings.  Dr.  Thorne  further  recommends  that 
in  the  case  of  a  smallpox  pavilion,  the  separation  between  it 
and  the  other  hospital  buildings  should,  if  possible,  be  even 
still  more  complete,  or  it  should  be,  as  at  Folkestone,  an 
entirely  separate  institution.  At  Folkestone,  too,  arrange- 
ments have  been  made  for  the  reception  of  better  class 
patients  into  a  separate  block  of  small  wards,  and  there  is 
no  doubt  that  such  an  addition  to  most  infectious  hospitals 
would  be  a  great  boon  to  paying  patients,  besides  affording 
means  for  isolating  noisy  or  delirious  patients  and  doubtful 
cases. 

The  construction  and  arrangement  of  the  ward  pavi- 
lions are  so  similar  to  the  details  already  given  with  regard 


278  HOSPITALS. 

to  general  hospitals  that  only  a  few  additional  particulars 
may  be  given  here.  The  cubic  space  per  bed,  according 
to  the  memorandum  of  the  Local  Government  Board, 
should  be  at  least  2000  feet,  and  the  minimum  floor  space 
per  bed  144  square  feet.  The  height  of  the  wards,  should 
be  about  14  feet,  and  no  additional  height  should  be  taken 
into  account  in  reckoning  the  cubic  space.  The  floors 
should  be  closely  jointed,  the  walls  either  covered  with 
Parian  cement,  or  made  smooth  and  limewashed  and 
coloured,  and  flat  ceilings  without  cornices  should  be  pre- 
ferred to  pitched  roofs.  The  windows  should  be  double- 
sashed,  and  be  evenly  distributed  in  the  opposite  walls,  so 
as  to  ensure  efficient  cross-ventilation.  The  best  arrange- 
ment is  found  to  be  that  which  provides  for  one  window 
between  every  two  adjacent  beds,  and  one  near  the  angles 
of  the  ward  beyond  each  end  bed.  They  should  reach 
from  about  3  feet  above  the  floor  level  to  within  6  inches 
of  the  ceiling  or  wall-plate,  and  the  amount  of  window 
space  should  be  in  the  proportion  of  1  square  foot  to  about 
70  cubic  feet  of  ward  space— r- too  much  window  space 
having  been  found  to  interfere  with  the  equable  warmth 
of  the  contained  air. 

In  addition  to  the  window  ventilation,  Dr.  Thome  re- 
commends that  there  should  be  ventilating  openings  under 
each  bed,  and  just  above  the  floor  level,  and  each  capable 
of  being  closed  by  means  of  a  small  sliding-door  on  one 
or  other  side  of  the  ward,  according  as  the  direction  of  the 
prevailing  wind  may  determine.  The  ward  ventilation 
should  be  supplemented  by  vertical  enclosed  shafts  passing 
through  the  roofs,  or  special  flues  opening  near  the  ceiling, 
and  carried  alongside  the  chimney  flues. 

With  regard  to  warming,  it  was  found  that  open  fire- 
places are  best  adapted  for  ward  purposes,  and  preferably 
those  of  the  ventilating  kind.  When  wards  exceed  30 
feet  in  length,  ventilating  stoves,  having  an  open  fire-place 


HOSPITALS.  279 

both  back  and  front,  should  be  provided  in  the  centre  of 
the  ward,  or  instead  of  these  close  ventilating  stoves  may 
be  substituted. 

In  connection  with  each  ward  pavilion  there  should 
be  an  entrance  lobby,  a  nurse's  room  fitted  with  fixed 
windows  to  command  a  view  of  either  ward,  a  room  in 
which  to  store  food,  and  a  linen  store.  In  small  hospitals 
the  nurse's  room  is  often  fitted  as  a  ward  kitchen,  and 
provided  with  a  scullery  sink.  In  two-storied  pavilions 
similar  apartments  should  occupy  the  end  of  the  ward 
which  adjoins  the  entrance  lobby  and  staircase.  At  the 
opposite  end  of  the  ward,  closets,  sinks,  and  bathing  accom- 
modation should  be  provided  in  a  building  projecting  from 
the  main  payilion,  as  already  described  in  Section  I.,  and 
separated  by  a  lobby  provided  with  efficient  means  of  cross- 
ventilation.  When  no  separate  bath-room  is  provided,  a 
movable  bath  on  wheels  is  found  to  answer  the  require- 
ments of  small  hospitals. 

It  need  hardly  be  said  that  the  drainage  should  be 
perfect  in  all  its  details,  and  the  water-supply  abundant 
and  wholesome.  Where  there  are  no  public  sewers  the 
closets  should  be  dry  closets,  provided  with  movable  recep- 
tacles, which  can  be  removed  through  a  small  doorway  in 
the  outside  wall,  and  the  best  way  of  treating  the  slops  is 
by  sub-irrigation  from  a  Field's  syphon  flush-tank.  (See 
Chapter  XL,  Section  VII.) 

The  furniture  of  the  wards  should  be  simple  and  neat ; 
and,  for  obvious  reasons,  all  bed-curtains,  carpeting,  or 
matting  should  be  prohibited.  The  best  kind  of  bedsteads 
are  iron  bedsteads,  provided  with  wire -woven  mattresses, 
and  thin  horse-hair  beds,  which  can  be  easily  disinfected 
in  a  disinfecting  chamber. 

The  outbuildings  should  consist  of  a  porter's  lodge,  if 
the  hospital  is  of  considerable  size,  a  mortuary,  a  laundry, 
an  ambulance  shed,  and  a  disinfecting  chamber,  and  if 


280  HOSPITALS. 

necessary  a  post-mortem  room — all  of  which  should  be 
built  at  a  safe  distance  from  the  pavilions. 

According  to  Dr.  Thome,  the  most  efficient  disinfecting 
chamber  is  the  one  devised  by  Dr.  Kansome,  of  Notting- 
ham ;  and  another,  which  has  been  highly  commended,  is 
the  disinfecting  chamber  devised  by  Dr.  Scott. 

Temporary  extension  of  the  accommodation  of  any 
hospital  may  be  provided  in  the  summer  and  autumn  by 
tents,  and  in  the  winter  and  spring  by  wooden  huts.  The 
tents  recommended  are,  the  regulation  bell-tent  of  the 
War  Department,  513  cubic  feet  space,  and  the  regulation 
hospital  marquee  of  3000  cubic  feet  space.  The  former 
should  not  contain  more  than  one  patient,  nor  the  latter 
more  than  three.  The  ground  on  which  they  are  pitched 
should  be  kept  dry  by  means  of  trenches  around  and  be- 
tween them ;  the  floors  should  be  boarded ;  the  approaches 
paved  or  boarded;  and  the  tents  themselves  should  be 
everywhere  distant  from  each  other  at  least  a  diameter 
and  a  half.  All  slops  and  refuse  matter  should  be  care- 
fully removed.  In  the  recent  outbreak  of  smallpox  at 
Wednesbury,  large  double  canvas  tents  were  used  with 
great  success,  and  it  was  found  that  they  could  be  effi- 
ciently warmed  with  hot-water  pipes. 

With  regard  to  huts,  "  dryness  of  site  is,  as  in  the  case 
of  tents,  of  the  first  importance.  Each  hut  should  be 
trenched  round.  Its  floor  should  be  raised  a  foot  or  a 
foot  and  a  half  from  the  earth,  so  as  to  permit  the  free 
under-passage  of  air ;  but  care  must  be  taken  to  prevent 
the  lodgment  of  moisture  or  impurities  beneath  the  floor. 
A  distance  not  less  than  three  times  the  height  of  a  hut 
should  intervene  between  any  two  huts,  and  each  hut 
should  be  so  placed  as  not  to  interfere  with  free  circula- 
tion of  air  round  other  huts.  In  huts,  as  in  permanent 
buildings  for  the  treatment  of  infectious  diseases,  not  less 
than  2000  feet  cubic  space,  with  144  square  feet  of  floor, 


HOSPITALS. 


281 


should  be  given  to  each  patient.  The  ventilation  of  huts, 
also,  is  of  equal  importance  with  that  of  permanent  hospital 
buildings.  It  is  best  secured  by  the  combination  of  side- 
windows  with  roof-opening,  the  latter  protected  from  rain, 
and  running  the  whole  length  of  the  ridge  of  the  roof. 
The  windows,  capable  of  being  open  top  and  bottom, 
should  not  be  fewer  than  one  to  each  pair  of  beds,  or  in 
large  huts  one  to  each  bed,  nor  should  be  of  less  size  than 
the  sash-window  in  common  use  for  houses.  The  venti- 
lating opening  beneath  the  ridge  may  have  flaps,  movable 
from  within  the  hut  by  ropes  and  pulleys,  so  that  the 
opening  to  windward  can  be  closed,  if  necessary,  in  high 
winds.  Double -walled  wood  huts  may  have  additional 
ventilation  by  the  admission  of  air  beneath  this  outer  and 
inner  wall,  and  its  passage  into  the  interior  of  the  hut 
through  openings  with  movable  covers  at  the  top  of  the 
inner  lining.  The  roof  should  be  covered  with  waterproof 
felt;  the  edges  of  the  felt  fastened  down  by  strips  of 
wood,  not  by  nails.  The  hut  should  be  warmed  by  open 
fire-places,  fixed  in  brick  stove  stacks  placed  in  the  centre 
of  the  floor,  the  flue  being  carried  through  the  roof." — (See 
Memorandum  of  Local  Government  Board.) 

D    Q    D 

1A1I   WAKO       GO      48   X  8* 

OLOOM. 


A DOIT^  ROOM* 

Fig.  11. 

The  above  is  a  ground-plan  of  a  hospital  hut  for 


282 


HOSPITALS. 


eight  patients  of  each  sex,  having  the  same  infectious 
disease. 

Fig.  12  is  a  ground-plan  of  an  extension  of  hut  hos- 
pitals for  ten  patients  of  each  sex,  having  the  same 
infectious  disease,  where  plenty  of  ground  is  available. 

Both  these  plans  are  copied  from  the  Memorandum 
of  the  Medical  Department  of  the  Local  Government 
Board  already  referred  to. 


Fig.  12. 


Fig.  12.— A,  Administrative  Buildings  (Kitchen,  Stores,  Offices,  Nurses'  Bed-rooms, 
etc.) ;  B,  Laundry,  etc. ;  C,  Disinfection,  Dead-house,  etc. ;  D,  Huts  for  10  patients 
each,  with  Scullery  and  Bath-room  at  end,  and  Closet  and  Sink  at  other  end  of  each  ; 
E,  Open  Corridors.  The  dotted  lines  show  direction  of  further  extension. 


Fig.  13. 


HOSPITALS.  283 

Fig.  13  is  the  ground-plan  of  a  hospital  which  was 
built  in  the  Solihull  Union,  which  forms  part  of  the  Mid- 
Warwickshire  sanitary  district,  in  1876.  The  general 
principles  of  the  plan  are  those  laid  down  in  the  Local 
Government  Board  Memorandum,  although  the  details 
were  modified  to  suit  local  circumstances.  The  central 
block  A  contains  a  kitchen,  bed-room,  larder,  small  sur- 
gery, etc.  There  is  a  doorway,  E,  in  each  corridor,  D,  so 
that  the  patients  in  the  blocks  B  and  C  can  be  kept 
completely  apart  if  required.  In  addition  to  these  blocks 
there  are  out-buildings  containing  a  porter's  lodge,  a 
disinfecting  chamber,  a  dead-house,  a  wash-house  and 
laundry,  and  a  shed  for  an  ambulance.  The  population 
of  the  Union  is  about  21,000,  and  the  site  covers  two 
acres  of  ground,  and  cost  £400. 

As  an  illustration  of  the  value  of  hospital  provision 
for  infectious  cases,  I  may  quote  Dr.  Buchanan's  remarks 
concerning  the  smallpox  hospital  in  Cheltenham,  from 
the  address  already  referred  to  : — "  Here  fourteen  beds 
are  permanently  provided  for  smallpox  cases  in  an 
admirable  little  hospital  that  is  devised  to  suit  the  wants 
of  well-to-do  people,  as  well  as  those  who  may  be  sent 
to  it  by  the  public  authorities.  In  six  months  of  last 
year  smallpox  was  brought  into  Cheltenham  no  less 
than  six  times,  from  Gloucester,  from  Birmingham,  from 
Liverpool,  and  elsewhere.  Seven  persons  ill  of  the  im- 
ported disease  were  taken  without  delay  to  the  Delaney 
Hospital,  and  except  one  individual,  who  was  also  re- 
moved to  the  hospital,  nobody  in  the  town  caught  the 
disease  from  these  centres  of  contagion.  There  was 
literally  no  other  smallpox  in  the  town.  How  much 
there  would  have  been  if,  in  the  absence  of  the  hospital, 
the  seven  importations  had  been  allowed  to  spread  their 
contagion  in  a  widening  circle  round  each,  can  of  course 
only  be  a  matter  of  surmise." 


284  HOSPITALS. 

The  management  of  a  small  infectious  hospital  would 
be  very  much  like  that  already  described  as  suitable  for 
a  cottage  hospital.  A  medical  officer  should  be  appointed 
who  would  have  full  powers  as  superintendent,  but  any 
patient  should  have  the  option  of  being  placed  under  the 
care  of  his  own  medical  attendant  should  he  desire  it, 
provided  he  pays  for  the  cost  of  attendance.  No  obstacles 
ought  to  be  thrown  in  the  way  of  admitting  patients, 
and  no  payment  should  be  insisted  on  except  in  special 
cases  or  where  private  wards  are  provided.  A  skilled 
nurse  can  always  be  obtained  on  the  shortest  notice 
from  any  of  the  excellent  nursing  institutions  advertised 
in  the  medical  papers.  At  times  when  the  hospital  is 
not  occupied,  the  building  and  bedding  should  be  kept 
clean  and  well  aired.  (For  Eules  of  Management,  see 
Appendix.) 

An  indispensable  adjunct  to  a  hospital  is  a  well- 
constructed  ambulance.  In  the  Appendix  will  be  found 
the  official  instructions  with  regard  to  ambulances  gener- 
ally, but  a  few  hints  introduced  here  may  likewise  prove 
serviceable.  A  one-horse  omnibus,  with  door  behind  and 
easy  springs,  can  be  converted  into  a  very  comfortable 
ambulance  by  taking  out  all  the  lining  and  polishing  or 
varnishing  the  wood  work.  The  space  beneath  the  driver's 
feet  should  be  utilised  in  extending  the  internal  space, 
and  this  should  receive  the  foot-end  of  the  stretcher.  The 
stretcher  should  be  made  of  wire  or  wicker  work,  and  the 
handles  should  be  jointed,  so  that  when  the  stretcher  is 
placed  in  the  ambulance  the  handles  will  not  encumber 
any  of  the  space.  Instead  of  a  stretcher,  a  net  hammock 
slung  on  hooks  will  be  found  to  be  a  very  comfortable 
mode  of  conveying  children  and  young  persons ;  indeed, 
for  that  matter,  there  ought  to  be  no  difficulty  in  sling- 
ing the  stretcher  itself  by  means  of  strong  indiarubber 
bands  attached  to  properly  fixed  hooks  or  bars.  Such 


HOSPITALS.  285 

an  arrangement  would  remove  much  of  the  discomfort 
arising  from  jolting,  which  good  springs  do  not  always 
prevent,  and  it  would  cost  little,  either  in  ingenuity  or  as 
regards  expense,  to  carry  it  out.  In  addition  to  the 
stretcher  or  hammock,  there  should  be  a  hinged  seat 
near  the  door  for  the  attendant,  and  one  or  two  hot 
water  cans  to  secure  sufficient  warmth  in  cold  weather 
and  during  a  long  drive.  After  being  used,  the  ambu- 
lance should  be  thoroughly  disinfected  by  being  washed 
with  a  strong  solution  of  sanitas,  or  any  other  disin- 
fectant which  does  not  leave  a  disagreeable  smell  after- 
wards. The  comfort  of  the  patient  would  be  greatly 
increased  if,  in  addition  to  good  springs,  the  ambulance 
were  provided  with  noiseless  wheels  having  indiarubber 
tires.  Particulars  with  regard  to  a  disinfecting  chamber 
will  be  given  in  Chap.  XIV. 

When  an  infectious  hospital  is  required  at  very 
short  notice,  it  may  be  run  up-  of  wood  or  corrugated 
iron ;  or,  to  meet  sudden  emergencies,  it  has  been  sug- 
gested that  "  flying  hospitals,"  consisting  of  two  or  more 
large  vans,  which  could  be  moved  by  road  or  rail,  would 
be  found  to  be  of  immense  service,  and  they  could  no 
doubt  be  so  arranged  as  to  be  made  quite  as  comfortable 
as  hut  hospitals.  Double  canvas  tents  pitched  on  wooden 
floors  have  also  been  utilised  to  meet  an  emergency  at 
Grantham,  Newark,  Wednesbury,  and  other  localities,  and 
with  a  large  amount  of  success. 

At  seaport  towns  it  is  proposed  to  use  hospital-ships 
of  the  "  Dreadnought "  type,  but  any  hull  of  an  old  vessel 
capable  of  floating,  and  large  enough,  would  suffice. 
Wooden  huts  erected  on  the  upper  deck  would  supply 
the  ward  accommodation,  while  the  body  of  the  vessel 
could  be  utilised  for  the  administrative  department.  Such 
hospital-ships  would  prove  of  immense  value  in  the  event 
of  cholera  again  visiting  this  country. 


286  HOSPITALS. 


SECTION  IV. — MORTUARIES. 

In  connection  with  this  subject  of  hospitals,  some 
hints  may  be  given  with  regard  to  public  mortuaries. 
By  Section  141  of  the  Public  Health  Act,  18*75,  it  is 
enacted  that  any  Sanitary  Authority,  whether  urban  or 
rural  "  may,  and  if  required  by  the  Local  Government 
Board,  shall,  provide  and  fit  up  a  proper  place  for  the 
reception  of  dead  bodies  before  interment,  and  may  make 
by-laws  with  respect  to  the  management  and  charges  for 
the  use  of  the  same ;  they  may  also  provide  for  the 
decent  and  economical  interment,  at  charges  to  be  fixed  by 
such  by-laws,  of  any  dead  bodies  which  may  be  received 
into  a  mortuary."  Further,  it  is  enacted  by  Section  142, 
that  "  when  the  body  of  one  who  has  died  of  any  infectious 
disease  is  detained  in  a  room  in  which  persons  live  or 
sleep,  or  any  dead  body  which  is  in  such  a  state  as  to 
endanger  the  health  of  the  inmates  of  the  same  house  or 
room,  any  Justice  may,  on  a  certificate  signed  by  a  legally 
qualified  medical  practitioner,  order  the  body  to  be  re- 
moved at  the  cost  of  the  Local  Authority  to  any  mortu- 
ary provided  by  such  Authority,  and  direct  the  same  to 
be  buried  within  a  time  to  be  limited  by  such  order." 

Such  are  the  provisions  of  the  Public  Health  Act, 
but  except  it  be  in  large  towns — and  even  in  them 
there  is  still  a  great  lack  of  adequate  mortuary  accom- 
modation— little  or  no  effort  has  been  made  by  Sanitary 
Authorities  in  this  direction,  and  hence  Section  142 
becomes  practically  inoperative.  Mr.  Burdett,  in  his 
excellent  work  on  Cottage  Hospitals,  already  referred  to, 
suggests  that  not  only  should  mortuaries  be  provided  at 
all  hospitals,  but  that  Sanitary  Authorities  should  contract 
with  hospital  managers  to  receive  bodies  from  overcrowded 
homes  on  payment  of  certain  fees  or  of  a  fixed  annual 


HOSPITALS.  287 

subscription.  The  estimated  cost  of  a  small  brick  build- 
ing, with  two  compartments,  including  mortuary,  two 
waiting-rooms,  and  a  disinfecting  chamber,  is  laid  down 
at  between  £200  and  £300.  For  large  towns  the 
mortuary  should  be  sufficiently  capacious  to  hold  ten 
or  twelve  bodies  placed  in  shells  or  coffins  resting  upon 
trestles  or  movable  iron  brackets  fixed  around  the  sides 
of  the  building.  The  post-mortem  room  should  be  ad- 
joining, but  quite  distinct  from  the  mortuary.  It  should 
be  well  lighted,  well  ventilated,  and  be  provided  with 
special  appliances  for  post-mortem  examinations.  There 
should  also  be  a  room  or  rooms  for  the  accommodation  of 
the  coroner  and  jury  in  inquest  cases,  as  at  Islington, 
Clerkenwell,  and  the  City  of  London.  As  regards  the 
regulation  and  management  of  mortuaries,  a  large  amount 
of  valuable  information  is  given  by  Mr.  Burdett  in  his 
work  on  Cottage  Hospitals. 


288  REMOVAL  OF  SEWAGE. 


CHAPTEE    XL 

REMOVAL    OF    SEWAGE. 

THE  term  sewage  may  be  conveniently  used  as  indicating 
the  excrementitious  matter  thrown  off  by  the  bowels  and 
kidneys,  and,  indirectly,  the  refuse,  whether  solid  or 
liquid,  which  is  constantly  accumulating  in  inhabited 
places,  and  requires  to  be  constantly  removed  if  cleanli- 
ness and  health  are  to  be  maintained.  A  consideration 
of  this  subject  will  therefore  have  reference  not  only  to 
the  different  methods  of  excretal  removal,  but  also  to 
scavenging. 

Although  in  thinly-populated  districts  it  might  be 
inferred  that  the  disposal  of  the  excreta  and  house- 
refuse  ought  to  be  attended  with  very  little  risk,  it  is 
found  practically  that,  owing  sometimes  to  nearness  to 
the  house,  or  at  other  times  to  being  close  to  the  well, 
the  midden  or  cesspool  frequently  becomes  the  cause  of 
severe  illness,  and,  if  the  contents  are  allowed  to  accumu- 
late, is  always  a  source  of  real  danger.  Even  when  a 
house  stands  widely  apart  from  every  other,  the  occupier 
cannot  safely  neglect  the  sanitary  obligation  which  rests 
upon  him  of  disposing  of  his  house  refuse,  whether  solid 
or  liquid,  so  that  there  shall  be  no  foul  smells  to  taint 
the  air,  nor  foul  leakage  from  drains  or  cesspools  to  pol- 
lute his  drinking  water  or  render  unhealthy  the  walls 
and  foundations  of  his  dwelling.  And  in  proportion  as 
houses  are  gathered  together  in  towns  or  large  villages,  it 


REMOVAL  OF  SEWAGE.  289 

need  hardly  be  said  that  this  sanitary  obligation  becomes 
more  and  more  important.  Yet  nothing  is  more  clearly 
established  in  the  numerous  reports  of  the  Medical  In- 
spectors of  the  Local  Government  Board  and  in  published 
reports  of  health  officers  from  all  parts  of  the  country, 
than  the  gross  and  utter  neglect  which  still  prevails  with 
regard  to  that  continuous  and  systematic  removal  of  all 
filth  which  can  alone  ensure  even  an  approach  to  clean- 
liness. 

In  the  words  of  Mr.  Simon — "  There  are  houses,  there 
are  groups  of  houses,  there  are  whole  villages,  there  are 
considerable  sections  of  towns,  there  are  even  entire  and 
not  small  towns,  where  general  slovenliness  in  everything 
which  relates  to  the  removal  of  refuse  matter,  slovenli- 
ness, which  in  very  many  cases  amounts  to  utter  bestiality 
of  neglect,  is  the  focal  habit ;  where  within,  or  just  outside 
each  house,  or  in  spaces  common  to  many  houses,  lies  for 
an  indefinite  time,  undergoing  foetid  decomposition,  more 
or  less  of  the  putrefiable  refuse  which  house-life,  and  some 
sorts  of  trade-life,  produce ;  excrement  of  man  and  brute, 
and  garbage  of  all  sorts,  and  ponded  slop-waters,  some- 
times lying  bare  on  the  common  surface  ;  sometimes  un- 
intentionally stored  out  of  sight  and  recollection  in  drains 
or  sewers  which  cannot  carry  them  away ;  sometimes  held 
in  receptacles  specially  provided  to  favour  accumulation, 
as  privy-pits,  and  other  cesspools  for  excrement  and  slop- 
water,  and  so-called  dust-bins  receiving  kitchen  refuse 
and  other  filth.  And  with  this  state  of  things,  be  it  on 
large  or  on  small  scale,  two  chief  sorts  of  danger  to  life 
arise ;  one,  that  volatile  effluvia  from  the  refuse  pollute 
the  surrounding  air  and  everything  which  it  contains ; 
the  other,  that  the  liquid  parts  of  the  refuse  pass  by 
soakage  or  leakage  into  the  surrounding  soil,  to  mingle 
there  of  course  in  whatever  water  the  soil  yields,  and  in 
certain  cases  thus  to  occasion  the  deadliest  pollution  of 

u 


290  REMOVAL  OF  SEWAGE.  " 

wells  and  springs.  To  a  really  immense  extent  -  -  to 
an  extent,  indeed,  which  persons  unpractised  in  sanitary 
inspection  could  scarcely  find  themselves  able  to  imagine, 
dangers  of  these  two  sorts  are  prevailing  throughout  the 
length  and  breadth  of  this  country,  not  only  in  their 
slighter  degrees,  but  in  degrees  which  are  gross  and 
scandalous,  and  very  often,  I  repeat,  truly  bestial.  And 
I  state  all  this  in  unequivocal  language,  because  I  feel 
that,  if  the  new  sanitary  organisation  of  the  country  is  to 
fulfil  its  purpose,  the  administrators,  local  and  central, 
must  begin  by  fully  recognising  the  real  state  of  the  case, 
and  with  consciousness  that  in  many  instances  they  will 
have  to  introduce  for  the  first  time,  as  into  savage  life, 
the  rudiments  of  sanitary  civilisation." 

"  A  second  point  which,  equally  with  the  above,  needs 
f  to  be  recognised  by  all  who  are  responsible  for  the  pre- 
vention of  filth -diseases,  is  —  that  filth  does  not  only 
infect  where  it  stands,  but  can  transmit  its  infective  power 
afar  by  certain  appropriate  channels  of  conveyance ;  that, 
for  instance,  houses  which  have  unguarded  drainage  com- 
munication with  cesspools  or  sewers  may  receive  through 
such  communication  the  same  filth-infections  as  if  excre- 
ment stood  rotting  within  their  walls  ;  and  that  public 
or  private  water-reservoirs  or  water-conduits,  giving  acci- 
dental admission  to  filth,  will  carry  the  infection  of  the 
filth  whithersoever  their  outflow  reaches.  Thus  it  has 
again  and  again  happened  that  an  individual  house,  with 
every  apparent  cleanliness  and  luxury,  has  received  the 
contagium  of  enteric  fever  through  some  one  unguarded 
_drain  inlet ;  or  that  numbers  of  such  houses  have  simul- 
taneously received  the  infection,  as  an  epidemic,  in  places 
where  the  drain  inlets  in  general  have  been  subject  to 
undue  air  pressure  from  within  the  sewer.  And  thus, 
equally,  on  the  other  hand,  it  has  again  and  again  hap- 
pened that  households,  while  themselves  without  sanitary 


REMOVAL  OF  SEWAGE.  291 

reproach,  have  received  the  contagium  of  enteric  fever 
through  some  nastiness  affecting  (perhaps  at  a  consider- 
able distance)  the  common  water-supply  of  the  district  in 
which  they  are." — (See  Mr.  Simon's  Reports' New  Series, 
No.  II.) 

In  describing  briefly  the  various  methods  of  sewage- 
disposal,  it  will  be  convenient  to  discuss  the  subject  under 
the  following  sections  : — 

1.  The  water  system. 

2.  The  privy  or  midden  system. 

3.  The  pail  system. 

4.  The  dry  system. 

5.  Lieurnur's,  and  other  continental  systems. 

6.  Systems  best  suited  for  rural  districts. 

7.  Disposal  of  slops. 

8.  Public  scavenging. 

With  regard  to  systems  other  than  the  water-carriage 
system,  most  of  the  information  here  collated  has  been 
obtained  from  the  valuable  joint-report  of  Dr.  Buchanan 
and  Mr.  Netten  Eadcliffe  (see  Mr.  Simon's  twelfth  Report 
to  the  Privy  Council),  and  from  the  still  more  elaborate 
report  of  Mr.  Netten  Eadcliffe,  contained  in  No.  II.  of  the 
New  Series  already  referred  to,  as  well  as  from  the  report 
on  sewage-disposal  issued  by  the  Local  Government  Board 
in  1876,  and  other  works. 

SECTION  I. — THE  WATER  SYSTEM. 

Where  there  is  no  unusual  difficulty  in  dealing  with 
the  sewage  at  the  outfall,  there  can  be  no  doubt  that  the 
water-carriage  system  of  sewage  removal  is  the  one  best 
suited  for  large  towns.  In  the  great  majority  of  towns, 
however,  this  difficulty  has  become  so  very  serious,  or  the 
drainage  in  parts  is  so  defective,  that  the  water  system 


292  REMOVAL  OF  SEWAGE. 

has  been  supplemented  by  other  plans,  varying  according 
to  local  requirements,  but  all  of  them  intended  to  deal 
more  particularly  with  fsecal  matters.  Apart  from  con- 
siderations of  cleanliness  and  convenience,  this  system 
possesses  the  additional  advantage  of  employing  the  same 
channels  for  the  removal  of  sewage  which  are  required  for 
the  removal  of  waste  water,  and  not  only  so,  but  the 
waste  water  can  in  this  way  be  utilised  as  a  very  efficient 
vehicle  for  the  conveyance  of  the  excreta.  In  most  cases 
the  subsoil  water,  surface  water,  and  the  water  used  for 
domestic  purposes,  are  all  eventually  discharged  by  the 
same  channels,  so  that  the  drainage  and  sewerage  of  a 
town  usually  form  part  of  the  same  system. 

1.  Drains  and  Sewers. — In  any  system  of  drainage 
intended  to  carry  off  surface  water  and  drain  the  subsoil, 
it  is  necessary  that  the  drainage  channels  should  have 
sufficient  area  and  declivity  to  maintain  the  discharge  of 
the  water  which  they  receive  at  all  times,  and  at  its 
fullest  flow.  This  quantity  will  of  course  depend  chiefly 
on  the  rainfall  of  the  locality  to  be  drained,  and  upon  the 
amount  entering  the  drains  from  other  sources.  Thus,  in 
country  districts,  the  water  to  be  carried  off  may  be  partly 
derived  from  porous  strata,  which  have  their  gathering 
ground  beyond  the  boundary  ridges  of  the  drainage-area  ; 
and  in  towns,  the  water-supply  artificially  brought  in  is 
added  to  the  amount  derived  from  the  drainage  of  the  in- 
habited district.  Moreover,  as  the  soil  acts  as  a  kind  of 
reservoir,  the  water  does  not  enter  the  drains  in  the  open 
country  as  rapidly  as  it  falls,  indeed  a  considerable  portion 
of  it  is  evaporated  or  absorbed  by  vegetation  ;  but  in 
towns  it  runs  off  the  roofs  and  paved  or  macadamised 
surfaces  almost  as  fast  as  it  is  delivered. 
..  Guided  by  these  considerations,  engineers  have  esti- 
mated that  the  capacity  and  declivity  of  the  water- 
channels  for  country  districts  should  be  sufficient  to 


REMOVAL  OF  SEWAGE.  293 

carry  off  the  greatest  available  rainfall  occurring  during 
twenty-four  hours  in  that  space  of  time,  whereas  m  towns 
they  should  be  capable  of  discharging  the  greatest  ^hourly 
rainfall  on  the  area,  and  the  greatest  hourly  supply  from 
other  sources.  The  depth  of  the  greatest  hourly  rainfall 
is  estimated  by  different  authorities  at  from  half  an  inch 
to  an  inch. 

In  small  towns,  where  the  storm- water,  or  greatest 
hourly  rainfall,  may  be  passed  over  the  surface  without 
causing  injury,  the  main  sewers  need  not  be  constructed 
of  a  capacity  to  discharge  it, — a  plan  which  has  been 
carried  out  at  Penzance  and  Carlisle.  In  other  towns, 
again — as  at  Dover,  Ely,  Eugby,  etc. — most  of  the  storm- 
water  is  carried  off  by  the  old  drain -sewers,  and  the 
sewage  by  separate  pipe- sewers ;  or  pipe-sewers  are  used 
exclusively  for  the  sewage,  and  separate  drains  are  con- 
structed for  the  subsoil  and  storm-waters.  This  is  called 
the  separate  system,  and  it  is  now  adopted  in  all  new 
plans  of  drainage  which  provide  for  the  treatment  of  the 
sewage. 

The  advantages  of  the  pipe- sewer  system  are,  that  If 
the  pipes,  if  strong  and  well  jointed,  prevent  percolation  ; 
that  they  can  be  quickly  laid,  and  require  much  less 
excavation  than  brick  sewers ;  that  they  can  be  made  of 
various  curves  to  suit  different  positions ;  and  that,  with 
a  proper  declivity,  they  are  not  liable  to  get  fouled. 
Another  great  advantage  depends  on  the  fact  that  the 
sewage  can  be  treated  without  excessive  dilution,  and 
when  a  pumping -station  is  required  at  the  outfall  the 
original  cost  and  working  expenses  are  much  lessened. 
On  the  other  hand,  the  pipe  system  does  not  fully  ensure 
the  important  hygienic  condition  of  drying  the  subsoil  if 
separate  drains  are  not  laid  down,  or  unless  subsoil  pipes 
are  conjoined  with  sewer  pipes,  as  in  the  system  devised 
by  Messrs.  Brooke  and  Son  of  Huddersfield  Brick  sewers, 


294  REMOVAL  OF  SEWAGE. 

however,  as  they  are  usually  constructed,  do  act  efficiently 
as  subsoil  drains,  but  at  the  same  time  it  must  not  be 
forgotten  that  all  such  sewers  are  more  or  less  leaky,  and 
are  therefore  a  constant  source  of  danger  to  any  wells  or 
water-mains  which  may  be  near  them. 

/  /  (1.)  Construction  of  Drain-Sewers. — The  main  drains 
or  sewers  of  a  town  are  underground  arched  conduits, 
built  of  brick  in  cement,  and  should  be  perfectly  water- 
tight. They  are  generally  laid  on  a  bed  of  concrete,  to 
prevent  sinking  of  any  part  of  the  track,  and  consequent 
fracture.  The  jsross^section  preferred  for  them  is  an  egg- 
shaped  oval,  with  the  small  end  downwards,  and  with  a 
width  of  at  least  2  feet,  to  allow  "men  to  enter  them  for 
the  purpose  of  cleansing  and  repair.  They  should  be 
laid  out  in  straight  lines  and  true  gradients  from  point  to 
point,  so  that  the  current  shall  have  a  velocity  of  not  less 
//than  I  foot,  and  not  more  than  4-|  feet,  per  second.  At 
each  principal  change  of  line  or  gradient,  arrangements 
should  be  made  for  inspection,  flushing,  and  ventilation ; 
and  at  all  junctions  or  curves  the  declivity  should  be  in- 
creased, to  compensate  for  friction.  No  sewers  or  drains 
should  join  at  right  angles,  or  directly  opposite  the  entrance 
of  others.  Tributary  sewers  should  deliver  in  the  direc- 
tion of  the  main  flow,  and  should  also  have  a  fall  into 
the  main  at  least  equal  to  the  difference  between  their 
diameters. 

Surface  -  drains  or  gutters  communicate  with  the 
under-ground  drains  by  gulley-holes,  which  are  covered 
with  gratings,  and  generally  fitted  with  syphon-traps  to 
prevent  the  escape  of  foul  air.  Branch  drains,  leading 
from  the  houses  and  from  the  adjoining  ground,  are 
usually  made  of  earthenware  pipes,  bedded  on  concrete, 
and  well  jointed  in  hydraulic  mortar  or  cement.  They 
should  never  be  less  than  4  inches  in  diameter,  and 
should  have  a  declivity  sufficient  to  ensure  a  velocity  of 


REMOVAL  OF  SEWAGE.  295 

flow  of  at  least  4^-  feet  per  second,  to  prevent  the  forma- 
tion of  deposits.  All  junctions  with  other  drains  or 
sewers  should  be  curved  or  acute-angled,  and,  whenever 
practicable,  they  should  be  made  in  a  vertical  or  trans- 
versely inclined,  instead  of  a  nearly  horizontal,  plane. 
Pipes  of  small  size  should  always  be  joined  on  to  pipes 
of  larger  size,  as  4-inch  pipes  into  6,  6  into  9,  and  9 
into  12. 

No  drain  should  ever  commence  in  the  basement  of  a 
house,  otherwise  the  up-draught  produced  by  the  increased 
inside  temperature  will  occasionally  draw  the  air  through 
any  trap.  House-drains  should  never  be  less  than,  or 
seldom  exceed,  4  inches  in  diameter,  and,  as  previously 
shown,  should  be  completely  disconnected  from  the  public 
sewers.  Cellars  should  be  drained  by  making  the  drain 
so  as  to  discharge  upon  a  trapped  grating  communicating 
with  the  drain  outside  the  wall  of  the  house,  or,  if  this 
cannot  be  readily  effected,  the  drain  should  be  trapped, 
and  well  ventilated  either  by  a  special  pipe  or  an  open 
grating.  Where  houses  have  to  be  drained  from  back  to 
front  through  the  basement,  the  drain-pipes  should  be 
carefully  jointed,  bedded  in  concrete,  and  ventilated  back 
and  front  outside  the  walls  of  the  house.  Sink-pipes,  and 
pipes  from  cisterns,  lavatories,  or  baths,  should  never  com- 
municate  directly  with  the  drains,  but  should  always  be 
carried  outside  the  walls  of  the  house,  and  be  made  to 
discharge  on  to  open  trapped  gratings  communicating  with 
the  drains.  All  soil-pipes  should  be  sufficiently  venti- 
lated, and  no  other  pipes,  such  as  overflow-pipes  from 
cisterns,  should  open  into  them. — (See  Chapter  on  Dwell- 
ings.) 

(2.)  Ventilation  of  Sewers. — In  order  to  prevent  con- 
centratiou  or  stagnation  of  the  gases  which  are  largely 
given  off  by  sewage,  it  becomes  a  matter  of  the  utmost 
importance  to  provide  numerous  Openings  communicating 


296  REMOVAL  OF  SEWAGE. 

with  the  sewers,  to  ensure  free  ventilation.  Main  sewers, 
with  steep  gradients,  should  have  a  manhole,  a  tumbling 
bay,  and  double  ventilating  arrangement,  at  intervals  of 
not  less  than  300  yards.  The  tumbling  bay  or  fall  is 
provided  to  allow  of  a  flap-valve  being  applied  to  the 
discharging  end  of  the  sewer,  and  thus  compel  the  gases 


Fig.  14. — Manhole,  Tumbling  Bay,  and  Double  Ventilating  Arrangement. 
(After  RAWLINSON.) 

to  ascend  through  the  ventilating  shaft.  One  or  more 
charcoal  baskets  may  be  placed  in  the  man-hole. to  deodor- 
ise the  sewer-air  as  it  escapes,  and  before  it  enters  the 
ventilating  chamber,  but  charcoal  should  never  be  used 
when  it  can  be  avoided,  because  it  impedes  free  ventila- 


REMOVAL  OF  SEWAGE.  297 

tion.  The  manhole  and  ventilating  chamber  are  built 
side  by  side,  and  together  constitute  the  ventilating  shaft. 

For  ordinary  sewer-ventilation,  the  manhole  without 
a  side  chamber  may  be  utilised  as  a  ventilating  shaft,  or 
efficient  ventilation  can  be  secured  by  making  a  sufficient 
number  of  direct  openings  into  the  crown  of  the  sewer. 
Manhole  covers  can  also  be  utilised  as  ventilators  by  in- 
serting an  open  grating  into  them.  In  cases  where  the 
sewer  runs  parallel  with  and  close  to  the  pavement,  it  is 
advisable  to  carry  the  ventilating  shaft  in  a  sloping  direc- 
tion to  an  open  grating  situated  in  the  centre  of  the  street. 
All  these  different  methods  of  sewer- ventilation  have  been 
carried  out  in  several  places  at  my  suggestion  with  respect 
to  sewers  which  when  first  laid  were  not  ventilated,  and 
have  been  found  to  answer  admirably.  The  mistake 
which  is  often  made  is  to  carry  out  extensive  improve- 
ments of  this  description  during  the  warm  months  of 
summer  or  autumn.  At  this  period  of  the  year  the  evolu- 
tion of  sewer-gases  is  greatest,  and  as  it  is  evident  that  it 
must  take  some  considerable  time  to  construct  a  large 
number  of  ventilating  shafts,  great  complaints  are  made 
of  the  foul  effluvia  which  are  discharged  through  the 
openings  which  are  first  made.  All  such  improvements, 
therefore,  should  be  carried  out  during  the  colder  months 
of  the  year,  when  the  sewers  are  better  flushed  and  sewer- 
gases  are  not  generated  so  rapidly. 

With  regard  to  the  number  of  openings,  it  may  be 
said  generally  that  the  terminals  of  all  drains  and  sewers 
should  be  ventilated,  and  the  junctions  of  branch  sewers 
with  main  sewers.  According  to  Mr.  Eawlinson  there 
should  be  not  less  than  18  fixed  openings  for  ventilation, 
or  1  at  intervals  not  greater  than  1.00  yards,  for  each 
mile  of  main  sewer.  Flap  valves,  or  other  contrivances, 
should  be  provided  for  the  outlet  ends  of  sewers,  to  pre- 
vent the  wind  from  blowing  in.  In  some  cases  street 


298  REMOVAL  OF  SEWAGE. 

gulleys,  if  left  untrapped,  could  be  utilised  as  ventilators. 
Indeed,  the  great  object  of  ventilation  is  by  means  of 
numerous  openings  to  so  dilute  the  sewer  air  as  to  render 
it  innocuous  and  imperceptible  to  the  senses.  Some 
ventilators  will  act  as  inlets  for  fresh  air,  and  others  as 
outlets,  according  to  the  direction  of  the  wind.  There 
can  be  no  doubt  that  direct  ventilation  when  properly 
carried  out  is  the  most  efficient,  and  if  sewers  are  pro- 
perly constructed  in  the  first  instance  and  kept  well 
flushed  there  should  be  no  nuisance  from  the  ventilators. 

Main  sewers,  liable  to  be  affected  by  the  rise  of  tides 
or  land  floods,  must  be  abundantly  ventilated,  in  order 
that  the  sewer  air  may  not  be  forced  back  into  the  tribu- 
tary sewers  and  drains.  To  provide  for  efficient  ventila- 
tion under  these  circumstances,  Drs.  Parkes  and  Sanderson, 
in  their  report  on  the  sanitary  condition  of  Liverpool, 
recommended  the  erection  of  lofty  shafts,  with  a  sectional 
area  at  least  half  as  great  as  that  of  the  sewers.  They 
condemned  the  ventilating  shafts  in  use  at  the  date  of 
the  inquiry  as  being  too  narrow,  and  ascertained  by  ex- 
periment that  the  Archimedean  screw  ventilators,  with 
which  the  shafts  were  supplied,  only  aided  the  extractive 
power  by  20  per  cent. 

(3.)  Flushing  of  Sewers. — As  offensive  discharges  of 
sewer-air  are  generally  due  to  the  formation  of  deposits, 
careful  attention  to  systematic  flushing  is  highly  essential. 
The  flushing  of  sewers  is  effected  by  damming  back  the 
water,  and  removing  the  obstruction  when  a  sufficient 
collection  is  made,  the  sudden  rush  clearing  away  any 
deposit  that  may  have  taken  place.  In  addition  to  the 
arrangements  for  flushing,  which  should  be  provided  at 
every  manhole,  there  should  also  be  a  flushing  chamber 
or  syphon  flush-tank  at  the  head  of  each  sewer  and 
drain,  such  chambers  being  flushed  either  from  the  mains 
where  there  is  a  public  water-supply  or  from  water- 


REMOVAL  OF  SEWAGE.  299 

carts.  If  the  flushing  is  carried  out  from  the  mains,  care 
should  be  taken  that  there  is  no  intimate  connection 
between  these  and  the  sewers.  Sewers  in  straight  lines, 
and  even  gradients  from  manhole  to  manhole,  can  be 
cleared  out  by  using  scrubbers. 

No  water  from  manufactories  of  an  elevated  tempera- 
ture should  be  allowed  to  enter  sewers  before  being  cooled, 
because  it  accelerates  putrefactive  changes  in  the  sewage. 
Blowing  off  steam  from  boilers  into  them  is  also  objec- 
tionable. 

With  a  system  of  sewerage  properly  constructed,  well 
ventilated,  and  regularly  flushed,  the  dangers  arising  from 
atmospheric  pollution  by  sewer -gases  is  reduced  to  a 
minimum.  Indeed,  the  amount  of  impurities  in  sewer- 
air  under  these  conditions  is  so  small  as  to  be  almost  in- 
appreciable to  the  sense  of  smell,  and  it  may  be  laid  down 
as  a  rule  that  whenever  foul  effluvia  are  given  off,  it  is 
an  indication  that  the  sewer  is  insufficiently  ventilated, 
imperfectly  flushed,  or  that  it  has  been  badly  constructed 
in  the  first  instance.  In  exceptional  cases  charcoal  may 
be  used,  but  it  is  wrong  in  principle,  as  it  cannot  deodor- 
ise sewer-gas  without  impeding  the  ventilation.  For- 
merly the  practice  of  employing  it  in  ventilating  shafts 
was  general,  but  all  who  have  practical  experience  in  the 
matter  are  now  agreed  that  direct  open  ventilation  is  the 
cheapest  and  most  effectual  method,  and  that  when  pro- 
perly carried  out  it  does  not  give  rise  to  nuisance.  When 
charcoal  is  used,  the  kind  best  suited  for  the  purpose  is 
ordinary  wood  charcoal,  broken  into  small  pieces  about 
the  size  of  coffee-beans,  and  clean  sifted.  The  layer  in 
the  tray  or  basket  should  never  be  more  than  3  inches 
deep,  otherwise  the  passage  of  the  air  would  be  almost 
completely  obstructed.  Charcoal  always  acts  most  effi- 
ciently when  kept  dry,  but  it  does  not  altogether  lose  its 
deodorising  powers  when  it  becomes  damp.  Instead  of 


300  REMOVAL  OF  SEWAGE. 

baskets,  Mr.  Baldwin  Latham  introduced  some  time  ago 
a  system  of  spiral  charcoal  trays  for  the  ventilation  of 
main  sewers. 

But  though  charcoal  may  thus  be  found  to  be  useful 
in  abating  the  nuisance  arising  from  the  effluvia  issuing 
through  an  exceptionally  situated  ventilator,  it  cannot 
be  too  strongly  urged  that  the  evil  of  a  foul-smelling 
sewer  should  be  dealt  with  at  its  source.  If  a  sewer  is 
old,  leaky,  or  otherwise  so  imperfect  from  original  faulty 
construction  as  to  be  nothing  but  an  elongated  cesspool, 
the  sooner  that  it  is  abolished  the  better.  Unfortunately, 
however,  sewers  of  this  description  exist  in  almost  every 
town ;  and  not  only  so,  but  the  gravest  errors  have  been 
perpetrated  in  laying  down  house-drains  in  total  ignorance 
of  sound  sanitary  principles,  and  with  the  grossest  care- 
lessness as  regards  workmanship. 

(4.)  Shone 's  Pneumatic  System. — Some  mention  ought 
to  be  made  here  of  this  system,  which  was  first  brought  to 
notice  at  the  meeting  of  the  Sanitary  Institute  of  Great 
Britain  at  Stafford  in  18*78,  and  has  since  then  received  a 
large  and  increasing  share  of  attention.  It  has  passed  the 
stage  of  experiment,  and  there  can  be  little  doubt  that  it  will 
greatly  assist  engineers  in  overcoming  many  of  the  diffi- 
culties with  which  they  have  hitherto  had  to  contend, 
more  especially  in  low-lying  and  undulating  districts, 
and  sea-board  towns.  By  means  of  sewage  ejectors,  which 
are  worked  by  compressed  air  conveyed  in  pipes  from  a 
central  station,  where  the  engine-power  may  be  either 
steam  or  water,  Mr.  Shone  proposes  to  force  the  sewage 
along  properly-constructed  pipes,  or  sealed  sewers  as  he 
calls  them,  to  the  outlet,  or  over  rising  ground.  The 
ordinary  gravitating  sewers,  properly  ventilated,  and  kept 
properly  flushed,  are  made  to  discharge  into  one  or  more 
collecting  stations  according  to  the  size  and  contour  of 
the  town ;  and  in  these  stations  are  placed  the  ejectors. 


REMOVAL  OF  SEWAGE.  301 

So  soon  as  the  sewage  is  forced  into  the  sealed  mains 
from  the  ejectors,  all  communication,  both  with  the  street 
and  house-sewers,  as  well  as  with  the  atmosphere  of  the 
town,  is  completely  severed,  and  the  sewage  is  harmlessly 
and  rapidly  hurried  on  to  the  outlet.  Flat  stagnant 
sewers  and  deep  cuttings  may  thus  be  avoided,  and 
pumping  in  many  instances  may  be  dispensed  with.  The 
system  has  been  in  operation  for  some  time  at  East- 
bourne, where  it  has  worked  to  the  entire  satisfaction  of 
the  Local  Board,  and  it  has  also  been  adopted  for  War- 
rington,  Worthing,  and  Winchester.  It  is  applicable  to 
mansions  and  large  public  buildings  as  well  as  to  towns, 
and  has  recently  been  applied  to  the  drainage  of  the 
West  London  District  Schools.  There  is  no  doubt  that 
the  system  possesses  many  advantages,  and  it  has  been 
so  highly  spoken  of  by  eminent  engineers  that  its  appli- 
cation for  the  removal  of  existing  defects  in  the  sewerage 
of  towns,  as  well  as  to  new  systems  of  sewerage,  will 
become  much  more  general  as  it  becomes  better  known. 

2.  Traps. — That  too  much  reliance  has  been  placed 
by  engineers  and  builders  on  the  efficacy  of  traps  for  the 
exclusion  of  sewer-air,  is  becoming  every  day  more  and 
more  evident.  Up  till  quite  recently  no  adequate  pro- 
vision was  made  for  drain  or  sewer  ventilation,  and  the 
consequence  was  that  mechanical  ingenuity  became  taxed 
to  the  uttermost  to  prevent  the  pent-up  sewer-gases  from 
forcing  their  way  through  the  terminals  of  drains  which 
for  the  most  part  were  situated  inside  houses.  When  hot 
water  is  poured  down  a  drain,  or  when  a  sewer  becomes 
suddenly  charged  with  a  large  volume  of  water,  as  after  a 
heavy  fall  of  rain,  the  forces  which  are  brought  to  bear 
within  the  sewer  are  far  greater  than  the  resisting  power 
of  any  trap,  and  the  displaced  gases  make  their  escape 
often  at  points  where  they  are  the  most  dangerous. 
There  are  few  traps  whose  resisting  power  exceeds  that  of 


302  REMOVAL  OF  SEWAGE. 

a  column  of  water  an  inch  and  a  half  in  height ;  indeed, 
the  greater  number  of  them,  as  for  example  common  bell- 
traps,  have  only  a  resisting  power  of  about  one-quarter 
of  an  inch.  Besides,  it  should  be  remembered  that  the 
water  in  an  otherwise  very  efficient  trap  will  absorb 
sewer-gas  on  one  side  and  discharge  it  but  little  changed 
on  the  other.  All  traps,  therefore,  should  be  regarded  as 
at  the  best  useful  auxiliaries  only,  for  in  no  case  will  they 
afford  protection  against  the  escape  of  foul  air  if  proper 
ventilation  be  neglected.  Some  traps,  such  as  the  com- 
mon bell-trap,  are  worse  than  useless,  because  they  are 
readily  removed,  often  forgotten  to  be  replaced,  and  are 
easily  broken.  Many  traps,  too,  and  especially  those 
which  are  supposed  to  protect  the  terminals  of  drains  in 
cellars  or  basements,  are  practically  useless,  because  the 
water  in  them  speedily  evaporates  and  is  seldom  renewed. 

Although  there  is  almost  an  infinite  variety  of  traps, 
the  most  useful  of  them  are  either  of  what  is  called  the 
mid-feather  description,  or  are  constructed  on  the  syphon 
principle.  Flap-traps  are  sometimes  used  for  sewers  or 
large  drains,  but  they  are  merely  hinged  valves  which 
permit  water  to  flow  in  one  direction  only,  and  are  also 
intended  to  prevent  the  reflux  of  sewer-air.  In  the  ball- 
trap,  a  floating  ball  is  lifted  up  when  the  water  rises,  and 
when  it  reaches  a  certain  level  the  ball  impinges  on  and 
closes  an  orifice. 

All  traps  constructed  on  the  mid-feather  principle 
have  one  or  more  partitions  dipping  down  into  the  water 
between  the  entrance  and  discharge  pipe,  and  as  water 
stands  in  the  trap  to  the  height  of  the  discharge-pipe,  the 
partition  is  always  under  water.  What  are  called  D-traps 
are  of  this  description,  and  the  common  bell-trap,  with 
its  various  modifications,  belongs  to  the  same  category, 
The  following  are  illustrations  of  useful  traps. 

Fig.  15  is  an  illustration  of  a  mud-intercepting  trap, 


REMOVAL  OF  SEWAGE.  303 

manufactured  by  Doulton  and  Co.,  and  by  means  of  the 
bucket-handle  inside  is  easily  cleaned  out.  Syphon  traps 
may  be  described  as  curved  tubes,  in  which  the_whole__of 
the  curve  should  be  always  full  of  water.  All  bath  and 
lavatory  pipes  should  be  trapped  in  this  way,  even  when 


Fig.  15.  Fig.  IH.-bimple 

Gulley  Trap. 

they  do  discharge  on  to  outside  gratings,  to  prevent  the 
entrance  of  cold  air.  Fig.  17  is  an  illustration  of  the 
syphon  trap  recommended  in  the  Annotated  Model  By- 
La  ws  of  the  Local  Government  Board  for  ventilating  and 
disconnecting  house-drains. 

Amongst  good  ventilating  traps, 
well  adapted  for  house -drains,  may 
be  mentioned  Banner's  patent  house- 
drain  trap,  Buchan's  patent  discon- 
necting and  ventilating  drain  trap, 
and  the  trap  known  as  "  The  patent 
Edinburgh  air-chambered  sewer  trap,"  manufactured  by 
Messrs.  Potts  and  Co.  of  Birmingham.  By  adopting  one 
or  other  of  these  appliances,  the  most  serious  defects 
connected  with  house -drainage  may  be  effectually  re- 
moved, provided  the  drains  are  well  enough  laid,  in 
the  first  instance,  to  prevent  leakage. 

Fig.  1 8  is  an  illustration  of  Gregen's  patent  air-inlet, 
manufactured  by  Doulton  and  Co.,  together  with  trap 
and  ventilating  pipe.  The  raised  rim  round  the  shaft 


304 


REMOVAL  OF  SEWAGE. 


prevents  the  entrance  of  any  dirt  into  the  drain,  and  the 
whole  apparatus  if  properly  applied  will  not  only 
effectually  disconnect  the  drains  of  any  house  from  the 
sewer  but  will  ensure  a  constant  current  of  fresh  air 


AIR  INLET 


Fig.  18. 

through  them.  At  the  same  time  all  waste-pipes  from 
sinks,  lavatories,  or  baths,  and  overflow  pipes  from 
cisterns,  should  be  carried  outside,  and  made  to  discharge 
on  trapped  gratings,  as  previously  shown  in  the  Chapter 
on  Dwellings. 

3.  Water -Closets. — The  situation,  construction,  and 
general  arrangement  of  the  water-closets  best  suited  for 
private  houses  have  already  been  described  in  the  Chapter 
on  Dwellings.  In  the  crowded  districts  of  large  towns, 
however,  the  ordinary  form  of  water-closets  has  proved  a 
failure,  partly  on  account  of  the  complicated  character  of 
the  contrivances  for  flushing,  but  chiefly  on  account  of 
the  carelessness  and  filthy  habits  of  the  poorer  classes. 
For  these  reasons  some  special  modifications  of  the  usual 
plan  of  closet,  suited  for  large  collections  of  people,  and 
whose  management  may  be  more  under  the  control  of  the 


REMOVAL  OF  SEWAGE.  305 

public  authorities,  have  been  devised  and  introduced  into 
several  large  towns.  The  arrangements  which  have  been 
found  to  answer  best  are  the  trough- closets  in  use  at  Liver- 
pool, the  tumbler-closets  in  use  at  Leeds  and  Birkenhead, 
and  what  is  known  as  the  "Bristol  Eject,"  in  use  at 
Bristol. 

(1.)  The  Trough-closet  may  be  described  as  consisting  \( 
of  a  series  of  closets  communicating  with  a  long  trough         ^ 
situated  beneath  and  behind  the  seats,  which  receives  the  £ 
excreta  from  each  closet  in  the  series.     The  lower  end  of  ^ 
the  trough  communicates  with  a  drain  leading  to  the  j^  ~ 
sewer  by  an  opening  which  is  closed  by  a  plug.     Behind  ^  ] 
the  back  wall  of  the  closet  there  is  a  small  space,  to  f  ^ 
which  no  one  has  access  but  the  scavenger,  and  from  ^  a 
which  alone  the  plug  can  be  raised  by  means  of  a  handle.   \ 
The  scavenger  visits  daily,  empties  the  trough,  washes  it 
out  with  a  hose  connected  with   a  hydrant,   and  again  >*  ' 
charges  it  with  water.  .  As  much  water  is  let  in  as  will  - 

,T  W^  V***-  VW<4JU    A,  Ttfttotft^    MJL**U.<>  —      ' 

cover  the  excreta  received  during  twenry-TourKours,  and 
so  prevent  any  smell.     The  closets  are  kept  clean  by  the  ^  p 
users,  and  an  inspector  visits   occasionally  to   see  that  '    f 
cleanliness  is  maintained.     Offenders  may  be  summoned, 
and  fined  or  imprisoned. 

Dr.  Buchanan  and  Mr.  Eaclcliffe,  in  the  report  already 
alluded  to,  make  the  following  observations  with  regard 
to  the  trough-closets  : — "  Nothing  could  be  more  admir- 
able than  the  working  of  the  Liverpool  arrangement,  and      f^ 
nothing  could  be  more  marked  than  the  difference  between     N^ 
them  and  what  are  called  water-closets  in  the  poor  neigh- 
bourhoods of  London  and  other  large  towns ;  "  and  this      r 
favourable  opinion  is  fully  confirmed  by  Mr.  Radcliffe  in 
his  more  recent  report. 

(2.)  The  Tumbler-closet  resembles  the  trough-closet  in 
its  general  plan  and  structure,  but  differs  from  it  in  regard 
to  the  arrangements  for  flushing.  At  the  upper  end  of 

x 


306  REMOVAL  OF  SEWAGE. 

the  tumbler- closet  trough  there  is  a  swinging  basin,  into 
which  water  is  constantly  trickling,  and  which  is  so  con- 
structed that  it  capsizes  whenever  it  becomes  full.  In 
this  way  the  contents  of  the  trough  are  every  now  and 
then  washed  into  the  drain,  at  longer  or  shorter  intervals, 
as  may  be  deemed  necessary.  Although  these  closets  are 
capable  of  doing  good  work,  it  appears  from  Mr.  Kadcliffe's 
report,  and  an  admirable  report  written  by  Mr.  Vacher, 
health  officer  for  Birkenhead,  that,  owing  to  want  of  proper 
supervision  and  an  insufficient  supply  of  water,  they  have 
practically  failed.  The  sanitary  flushing-closets,  manu- 
factured by  Wilcock  and  Co.,  Leeds,  with  automatic 
flushing  arrangements,  would  answer  much  more  satis- 
factorily. 

(3.)  The  Bristol  Eject. — According  to  Mr.  Eadcliffe, 
this  consists  of  a  strongly  constructed  dip-trap  interposed 
between  the  privy  trunk,  as  the  receptacle  is  termed,  and 
the  drain.  It  thus  admits  of  the  ready  extraction  of 
foreign  matters  which  may  be  thrown  in,  it  is  not  easily 
broken,  and  as  it  is  flushed  and  kept  clean  by  the  servants 
of  the  corporation,  it  is  found  to  answer  much  better  than 
ordinary  water-closets  among  the  poorer  classes  of  large 
towns. 

For  barracks,  prisons,  etc.,  water  latrines  of  a  much 
simpler  construction  than  either  of  the  above  answer 
exceedingly  well.  An  open  metal  trough  roofed  in,  and 
with  the  necessary  partitions  and  doors,  receives  the 
excreta,  while  its  anterior  upper  margin  constitutes  the 
seat.  In  order  that  the  excreta  may  be  constantly  covered, 
the  trough  should  be  kept  one-third  full  of  water.  It 
should  also  be  well  flushed  at  least  twice  daily,  and  the 
contents  allowed  to  run  off  into  a  drain  connected  with  a 
sewer.  A  plug  or  flap-door  at  the  lower  end  of  the  trough 
will  be  required  to  prevent  the  water  from  draining  off 
during  the  intervals. 


REMOVAL  OF  SEWAGE.  307 

There  is  a  further  advantage,  common  to  all  closets 
of  the  trough  system,  which  may  here  be  pointed  out. 
In  the  event  of  an  epidemic  of  cholera  or  enteric  fever 
raging  in  the  crowded  courts  where  these  closets  are  in 
use,  it  will  be  an  easy  matter  to  throw  disinfectants  into 
the  troughs,  and  thus  destroy  the  infectious  power  of  the 
alvine  discharges. 

(4.)  Intercepting  Tanks. — This  system  of  intercepting 
the  solids  and  allowing  the  liquid  part  of  the  sewage  to 
run  off  into  the  drains,  has  been  advocated  by  many,  on 
the  grounds  that  the  manure  thus  collected  can  be  readily 
utilised,  that  there  is  no  risk  of  clogging  up  the  sewers, 
and  that  the  sewers  themselves  may  be  constructed  of 
much  smaller  dimensions.  Many  of  the  fosses  perma- 
nentes  and.  fosses  mobiles  on  the  Continent  are  constructed 
on  this  principle,  and  in  this  country  a  tank  has  been 
introduced  by  Mr.  Chesshire  of  Birmingham,  which  has 
been  well  spoken  of  by  Dr.  Parkes,  and  Dr.  Hewlett, 
health  officer  of  Bombay.  The  following  is  the  patentee's 
description  of  the  tank  : — "  The  plan  or  form  at  present 
preferred  is  that  of  an  iron  box,  large  enough  to  hold  the 
solid  part  of  the  excreta  of  an  average  household  for  from 
eight  to  twelve  months,  and  yet,  when  full,  within  the 
power  of  two  strong  men  to  lift.  This  box  is  2  feet  4 
inches  long,  by  18  inches  wide  and  18  inches  deep.  The 
pipe  from  the  privy  or  closet  passes  into  the  top  of  the 
box,  by  preference  at  the  opposite  corner  to  the  outlet  or 
waste-pipe,  which,  placed  at  the  bottom  of  the  box,  is 
divided  from  the  main  part  by  a  perforated  grating  ex- 
tending across  the  corner  and  the  whole  height  of  the 
box.  Except  as  to  the  inlet  and  outlet  pipes,  the  box  is 
hermetically  sealed,  though  the  lid  can  be  readily  removed 
when  it  is  desirable  to  empty  it.  The  connection  of  the 
inlet  and  outlet  pipes  to  the  box  can  also  readily  be  sepa- 
rated and  re-made  without  the  assistance  of  the  plumber." 


308  REMOVAL  OF  SEWAGE. 

It  is  doubtful,  however,  whether  this  or  any  other 
plan  which  merely  intercepts  the  solids,  can  ever  be  com- 
mended for  extensive  use.  For,  on  the  one  hand,  the 
prevention  of  the  more  solid  portion  of  the  excrement 
from  entering  the  drains  does  not  materially  lighten  the 
sewage-problem ;  and,  on  the  other,  the  detention  of  filth 
on  premises,  even  though  it  be  in  close  boxes,  is  wrong 
in  principle,  and  cannot  be  regarded  as  free  from  danger. 
Indeed,  the  advantage  above  all  others  which  attaches  to 
the  water-closet  system  when  efficiently  carried  out,  is  the 
continuous  and  complete  removal  of  all  excremental  mat- 
ters from  dwellings. 

(5.)  Urinals. — These  should  be  lined  with  glazed 
stoneware  tiles,  or  enamelled  slabs  of  smooth  slate.  They 
can  be  kept  perfectly  clean  and  inodorous  by  allowing  a 
small  quantity  of  water  to  trickle  down  them  constantly. 

In  all  towns  of  any  size  it  is  a  great  desideratum  on 
the  score  of  cleanliness,  health,  and  convenience,  to  pro- 
vide public  lavatories  in  suitable  localities,  supplied  with 
water-closets,  urinals,  and  washhand  basins, — and  they 
should  be  provided  for  the  female  as  well  as  for  the  male 
sex.  At  Nottingham  a  ladies'  lavatory  has  recently  been 
provided  by  the  Corporation,  which  about  pays  for  interest 
on  outlay  and  attendance,  and  in  Glasgow  three  such  lava- 
tories have  also  lately  been  opened. 

SECTION  II. — THE  PRIVY  OR  MIDDEN  SYSTEM. 

From  what  has  already  been  said,  it  is  obvious  that 
the  privy  or  midden  system  of  old  type,  with  leaky  and 
foetid  cesspits  behind,  is  totally  inapplicable  to  populous 
places.  Cesspools  and  large  deep  ashpits  in  connection 
with  privies  are  equally  objectionable,  no  matter  what 
precautions  be  taken.  To  improve  the  system  so  as  to 
render  it  even  tolerable,  it  is  essential  that  the  pit  should 


REMOVAL  OF  SEWAGE.  309 

be  small  in  order  to  secure  frequent  removal  of  the  con- 
tents ;  that  it  should  be  shallow  and  perfectly  water-tight 
to  prevent  leakage ;  that  it  should  be  roofed  in,  to  keep 
out  rain  ;  that  it  should  be  well  ventilated  ;  that  it  should 
be  easy  of  access ;  that  it  should  be  at  a  safe  distance  from 
the  house ;  and  that  the  contents  should  be  kept  dry  and 
inoffensive  by  means  of  sifted  ashes  or  other  dry  refuse. 
It  is  not  necessary  that  it  should  be  drained,  for  if  the 
ashes  do  not  keep  the  excreta  dry  the  system  is  a  failure. 
According  to  Mr.  Netten  Radcliffe,  the  only  kinds  of 
midden-privies  which  were  found  to  answer  all  these  re- 
quirements fairly  well  are  the  improved  middensteads  of 
Hull  and  Glasgow.  The  Hull  middenstead  consists  solely 
of  the  space  under  the  closet  seat,  and  its  floor  is  formed 
by  a  flag  which  slopes  downwards  to  the  back  wall  at  the 
ground-level  there.  The  ashes  are  thrown  in  through  the 
hole  in  the  seat,  and  the  front  board  of  the  seat  is  movable, 
to  enable  the  scavenger  to  get  at  the  contents,  which  are 
removed  weekly.  Privies  of  this  description  can  be  built 
for  about  £3.  The  Glasyow  middenstead  is  proportionately 
of  smaller  size  than  the  Hull  middenstead,  but  is  extended 
sufficiently  far  back  from  the  seat  to  admit  of  the  ashes 
being  thrown  upon  the  excrement  from  behind.  As 
several  families  use  one  privy,  the  contents  are  cleared 
away  every  two  days. 

Other  schemes,  intended  to  diminish  the  offensiveness 
of  large  middensteads,  as  observed  in  Manchester,  Salford, 
Nottingham,  and  elsewhere,  were  all  found  to  have  practi- 
cally failed.  In  Manchester,  where  many  of  them  were 
drained  into  the  sewers,  it  was  discovered  that  the  sewers 
were  becoming  gradually  choked  up  with  sediment. 


KKMOVAL  OK  SKWAOK. 


SECTION  III. — Tin.  PAIL  81 

The  more  common  varieties  <>\  thin  system  arc  the 
following : — 

1.  Pails  used  without  preparation  (Glasgow). 

2.  Pails  supplied  with  a  deodorant  and  anti-septi-- 
(Kochdale,  Birmingham,  Nottingham,  Leeds). 

3.  Pails  lined  on  the  Goux  system  (Halifax). 

4.  Pails  in  which  ashes  and  house-refuse  as  well  as 
excrement  arc  deposited  (Kdinbnr;_di,  Nottingham;. 

...     l';iil:i  into  which  co;d   ;r,he     are  :rreened   above  the 

excrement  (Manchester,  Salford,  Cockermouth;. 

In  order  to  carry  out  this  system  in  the  most  efficient 
manner,  two  pails  are  required  i«r  each  closet,  one  to 
receive  the  excreta,  and  the  other  the  ,-.  h»-  ;,nd  house- 
refuse.  The  excrement  pail  may  be  either  n  wooden  pail 
or  tub,  as  used  at  Ilochdale,  Nottingham,  and  Hal i In  ;  01 
it  may  be  of  metal,  such  as  that  used  in  Manchester, 
Leeds,  and  Glasgow.  In  either  case  it  is  requisite  tli;>i 
it  should  be  round,  so  that  it  can  be  easily  cleaned,  ;md 

!<•••. u<l     <  ;ipiM:il,y  ii.nd   (:oijvr;iii»-.iif:<;  I'oj'  jc,jnov;d,  its  cubic 

contents  should  not  exceed  10  gallons.  If  of  wood  it 
should  be  tarred  or  creosoted,  and  if  of  metal  it  liquid 

l*c  in;id«-  -,]••.:!  ;,ui:;«td  iron.  All  p;i.il:-;  ,'ihoidd  he  provided 
with  tight- fitting  lids,  such  as  Haresceugh's  excreta  p;<il 
with  patent  spring  lid,  so-  that  they  can  be  carted  away 
without  creating  nuisance.  When  one  pail'  is  removed, 
another,  which  has  been  thoroughly  cleaned  after  having 
been  emptied  at  the  depot,  should  be  left  in  its  stead, 

The,  jisli  p;n'l  .should  he  somewhat  larger  than  the  ex- 
crement pail,  and  may  be  either  a  rectangular  box  of  ban  d  y 
dimensions,  a  tub,  or  a  galvanised  iron  pail. 

In  the  Goux  system  as  carried  out  at  Hal i !;<;:,  the 

tuh:i  ;ire  lined   willi  .'-:onie  dry  :d,:.orhc.ut    in;i.t«-ri;d,  :;uch  fi:i 


REMOVAL  OF  SEWAGE.  311 

chaff,  straw,  shoddy  fluff,  hay,  dry  ferns,  or  any  kind  of 
animal  and  vegetable  matter  which  is  useless  for  other 
purposes.  The  patentees  direct  that  these  materials  are 
to  be  mixed  in  such  proportions  as  may  be  most  conve- 
nient, together  with  a  small  percentage  of  sulphate  of  iron 
or  sulphate  of  lime.  The  materials  are  pressed  close  to 
the  bottom  and  sides  of  the  tub  by  means  of  a  mould, 
which  is  afterwards  withdrawn.  A  separate  bin  must  be 
used  for  the  ashes  and  house-refuse ;  but  urine  may  be 
emptied  into  the  tub,  and  is  supposed  to  be  absorbed 
by  the  lining,  the  excreta  remaining  tolerably  dry.  The 
tub  is  removed  once  or  twice  a  week,  according  to  cir- 
cumstances. 

When  these  closets  are  well  managed,  they  are  clean 
and  inoffensive,  and  the  system  generally  has  been  favour- 
ably reported  on  by  Mr.  Haviland  of  Northampton,  and 
Mr.  Syson  of  Huntingdon,  as  well  as  by  Mr.  Netten 
lladcliffe.  On  the  other  hand,  it  has  been  asserted  that 
the  material  used  for  packing  generates  swarms  of  minute 
flies ;  and  that,  in  other  respects,  the  system,  as  it  is  usually 
curried  out,  is  not  free  from  nuisance.  Although  there 
is  perhaps  too  much  importance  attached  to  the  absorbent 
power  of  the  packing  material,  there  can  be  no  doubt 
that  the  advantages  of  the  Goux  system,  when  compared 
with  the  rnidden  system,  cannot  well  be  over-rated.  When 
properly  managed  there  is  less  offensiveness  than  with  the 
ordinary  pail  system,  while  the  resulting  manure  is  much 
more  easily  dealt  with,  and,  it  is  said,  commands  a  readier 
;>!<•,  than  ordinary  pail  closet  manure  mixed  with  ashes. 
In  a  letter  dated  March  1883,  the  Medical  Officer  of 
Health  assures  me  that  the  Goux  system  is  extending 
every  year  in  Halifax,  and  continues  to  give  every  satis- 
faction. 

In  Manchester,  Salfbrd,  and  other  large  towns,  a  dry 
ash  system  of  excrement-disposal  has  been  combined  with 


312  REMOVAL  OF  SEWAGE. 

a  pail  system ;  and  in  some  places  Morrell's  patent  self- 
acting  cinder -sifting  ash -closets  have  been  extensively 
introduced. 

As  to  the  kind  of  closet  best  suited  for  the  pail 
system,  it  is  found  that  a  closet  somewhat  after  the  im- 
proved Hull  or  Glasgow  pattern,  but  with  level  floor  and 
with  space  enough  to  contain  the  ash-pail  as  well  as  the 
excrement  pail,  is  the  cheapest  and  most  convenient. 
According  to  Mr.  Netten  Kadcliffe,  "  it  would  be  diffi- 
cult to  suggest  any  great  improvement  upon  the  patterns 
adopted  in  Rochdale,  Manchester,  and  Halifax.  The  com- 
pactness of  the  plan  and  the  facility  with  which  the 
pail- closet  can  be  adapted  to  the  varied  requirements  of 
old  towns  in  the  reconstruction  of  midden-closets,  is  most 
instructively  shown  in  the  plans  given  of  adaptations  in 
Halifax." 

But  in  all  large  towns  the  great  difficulty  which  has 
to  be  encountered  rests  mainly  on  the  disposal  and  treat- 
ment of  the  ashes,  refuse,  and  pail  contents  after  they 
have  been  collected.  The  following  is  a  description  of 
the  system  carried  out  in  Warrington,  and  I  beg  here  to 
express  my  indebtedness  to  Mr.  Longdin,  surveyor  of  that 
borough,  for  the  details  : — 

(1.)  Ashes,  etc.,  collected  in  ash-tubs. — These  are  dis- 
charged at  the  ground-level  of  the  depot,  and  lifted  by  an 
elevator  and  cast  into  an  automatic  cinder-screen,  which 
separates  the  material  into  two  portions,  viz.  fine  ash  and 
coarser  substances.  The  fine  ash  is  discharged  at  a  point 
sufficiently  high  that  it  can  be  shot  into  a  cart  without 
labour,  and  afterwards  removed  and  mixed  with  such 
portion  of  the  pail -contents  as  will  furnish  a  manure 
sufficient  to  satisfy  the  local  demand.  The  coarser 
materials  are  discharged  into  the  top  of  a  furnace  called 
a  "  Destructor,"  which  is  almost  self-feeding,  and  all  that 
is  required  is  to  break  up  and  remove  the  clinkers.  The 


KEMOVAL  OF  SEWAGE.  313 

heat  generated  in  the  process  of  combustion  passes  under 
and  through  a  multitubular  boiler,  and  generates  steam 
for  furnishing  the  power  required  for  working  the  whole 
machinery.  The  clinkers  from  the  "Destructor"  are 
passed  into  a  mortar-mill,  which  reduces  them  to  powder, 
and  this  is  either  sold  as  sand  or  mixed  with  lime  to  form 
an  excellent  and  tenacious  mortar. 

(2.)  Street  sweepings,  including  vegetable  and  animal 
refuse.— This  refuse,  which  consists  mainly  of  sw.eepings 
from  the  markets  and  streets,  is  discharged  on  the  ground- 
level,  and  raised  by  an  elevator  to  a  platform,  and  thence 
passed  into  a  furnace  called  a  "  Carboniser,"  which  con- 
verts all  vegetable  material  into  charcoal.  The  fuel 
required  for  heating  this  furnace  consists  of  a  portion  of 
the  sifted  cinders  from  the  ash-tubs.  The  charcoal  pro- 
duced is  a  powerful  deodorant,  and  what  is  not  used  for 
mixing  with  the  pail-contents  is  sold  at  20s.  per  ton. 

(3.)  Pail -contents. — The  bulk  of  these,  which  have 
not  been  mixed  with  fine  ashes  or  charcoal,  are  emptied 
on  the  ground-level  into  a  covered  tank,  and  are  conveyed 
by  means  of  a  chain -pump  into  an  elevated  air-tight 
store  -  tank.  After  having  ^been  mixed  with  a  small  por- 
tion of  acid  to  fix  the  ammonia,  the  thicker  portion 
of  the  material  settles  to  the  bottom  of  the  tank.  The 
more  liquid  contents  are  drawn  off  into  two  "Evapor- 
ators," which  are  tall  cast-iron  cylinders,  each  containing 
near  its  lower  end  a  drum-shaped  heater,  precisely  resem- 
bling a  multitubular  steam-boiler.  These  cylinders  are 
partially  filled,  and  the  heating -drums  are  covered  with 
the  thin  liquid;  steam  is  introduced  into  the  heating- 
drums,  and  the  liquid  becomes  partially  concentrated. 
When  the  contents  have  lost  by  evaporation  the  greater 
portion  of  their  water  they  are  drawn  off  into  a  machine 
called  a  "  Firman's  Dryer,"  along  with  the  thick  portions 
of  the  pail-contents  which  have  settled  in  the  store-tank. 


314  REMOVAL  OF  SEWAGE.  ' 

This  machine  consists  of  a  steam -jacketed  horizontal 
cylinder,  traversed  by  a  steam-heated  axis  and  by  steam- 
heated  revolving  arms,  and  furnished  with  scrapers  to 
keep  the  inner  surface  of  the  cylinder  free  from  accumu- 
lations of  dried  excreta.  The  pail-contents  are  admitted 
into  the  "  Dryer "  at  the  consistency  of  thin  mud,  and 
after  treatment  this  mud  emerges  as  a  dry  powder 
resembling  guano  in  appearance  and  quality. 

The  method  of  working  this  important  mode  of  con- 
centration is  thus  summarised  : — "  The  vertical  concen- 
trating vessel  first  described  is  supplied  with  steam  direct 
from  the  boiler,  and  the  '  Firman's  Dryer '  is  supplied  in 
like  manner.  The  steam  and  vapour,  however,  which  are 
driven  off  from  the  concentrating  vessel  and  the  '  Dryer,' 
instead  of  being  allowed  to  escape  into  the  air  or  being 
condensed  by  cold  water,  are  used  to  furnish  heat  to  the 
large  or  main  concentrating  apparatus,  which  is  kept 
boiling  at  a  low  temperature.  This  is  effected  by  con- 
ducting the  boiling  below  atmospheric  pressure  in  a 
vacuum  which  is  maintained  by  an  air-pump  attached  to 
the  steam-engine.  This  larger  vessel  is  in  fact  a  vacuum 
pan.  The  apparatus  is  so  connected  with  tubes  and 
valves  that  the  'Firman's  Dryer'  may  also  be  worked 
under  vacuum  if  necessary.  The  whole  of  the  vessels  are 
enclosed.  All  the  steam  generated  is  condensed,  and  the 
odour  given  off  during  the  process  is  also  passed  through 
the  '  Destructor '  fire  arid  destroyed.  From  the  time  the 
liquid  material  enters  the  store-tank  there  is  no  oppor- 
tunity for  odour  to  escape  into  the  air,  as  it  is  kept 
closely  under  cover  until  it  finally  emerges  as  a  dry 
powder.  The  manure  made  by  this  process  closely 
resembles  guano  in  appearance  and  quality,  and  is  sold 
at  £6  : 10s.  per  ton  at  works." 

After  the  pails  are  emptied  they  are  thoroughly 
cleansed  and  disinfected. 


REMOVAL  OF  SEWAGE.  315 

The  operations  at  the  depot  are  conducted  without 
the  purchase  of  any  coal,  and  they  are  so  arranged  that 
in  case  of  any  interruption  to  the  new  process  the  old 
can  be  continued  efficiently  and  with  much  less  cost  than 
formerly. 

This  process  of  purification  by  fire,  as  it  is  called,  has 
also  been  adopted  by  Birmingham,  Leeds,  Eochdale,  Man- 
chester, and  other  towns;  and  so  far  it  appears  to  have 
solved  the  difficulty  of  dealing  satisfactorily  with  such 
refuse  of  towns  as  is  not  disposed  of  by  means  of  the 
sewers. 

The  "  Destructor  "  and  "  Carboniser  "  have  both  been 
devised  by  Mr.  Fryer,  of  the  firm  of  Manlove,  Alliott, 
Fryer,  and  Co.,  engineers,  Nottingham ;  while  Firman's 
patent  "  Dryer  "  is  also  supplied  by  the  same  company. 

The  whole  of  this  process  is  fully  described  and  dis- 
cussed in  an  excellent  report  on  the  "  Disposal  of  Kefuse  " 
by  Dr.  Sedgwick  Saunders,  Medical  Officer  of  Health  to 
the  City  of  London,  published  in  1881.  In  this  report 
Dr.  Saunders  further  recommends  that  condemned  butcher- 
meat  and  carcases,  after  being  crushed  in  a  mill  called  a 
"  Devil,"  should  be  treated  in  a  Firman's  Drying  Apparatus, 
which  separates  the  fat,  and  reduces  the  bone  and  other 
tissues  to  a  fine  fertilising  powder.  Whether  in  desiccat- 
ing liquid  excreta  or  other  foul  refuse,  the  great  advantage 
attaching  to  this  process  is  that  it  can  be  carried  on 
without  creating  any  nuisance. 

SECTION  IV. — THE  DRY  SYSTEM. 

The  difference  between  what  is  called  the  dry  system 
of  excretal  removal  and  the  pail  system  depends  upon 
the  deodorising  and  destroying  power  of  the  dried  earth 
or  other  material,  which,  if  used  in  sufficient  quantity, 
converts  the  mixture  into  a  uniform  and  inoffensive  mass. 


316  REMOVAL  OF  SEWAGE. 

1.  Moide's  Earth- closet. — This  consists  of  a  wooden 
box  with  a  receptacle  or  pail  beneath,  a  reservoir  for  the 
dry  earth  above,  and  an  apparatus  for  measuring  and 
delivering  the  requisite  quantity  of  earth  whenever  the 
closet  is  used.  The  closet  is  made  self-acting  by  means 
of  a  spring  in  connection  with  the  seat,  or  it  is  worked 
by  a  handle  as  in  the  ordinary  water-closet.  It  is  essen- 
tial that  the  earth  be  previously  dried  and  sifted,  that  a 
sufficient  quantity  be  thrown  into  the  pail  before  the  closet 
is  used,  and  that  the  same  amount  be  delivered  over  each 
particular  stool.  The  quantity  requisite  for  the  deodorisa- 
tion  of  each  stool  (inclusive  of  the  urine)  is  found  to  be 
1J  Ib.  The  slops  and  the  rest  of  the  urine  must  be  re- 
moved in  some  other  way. 

This  system  has  been  introduced,  with  more  or  less 
success,  into  several  public  establishments  in  this  country 
(Broadmoor  Lunatic  Asylum,  the  Manx  Lunatic  Asylum, 
Isle  of  Man,  the  Beading  Workhouse,  etc.),  at  the  Wim- 
bledon Camp,  and  several  villages  throughout  the  country. 
Its  use  in  India  has  been  very  highly  spoken  of  by  Dr. 
Mouatt,  late  Inspector  of  Indian  Gaols. 

Dr.  Buchanan,  in  Mr.  Simon's  report  for  1869,  makes 
the  following  summary  with  regard  to  the  working  of  the 
earth  system : — 

"  (1.)  The  earth-closet,  intelligently  managed,  furnishes 
a  means  of  disposing  of  excrement  without  nuisance  and 
apparently  without  detriment  to  health. 

"  (2.)  In  communities  the  earth-closet  system  requires 
to  be  managed  by  the  authority  of  the  place,  and  will  pay 
at  least  the  expenses  of  its  management. 

"  (3.)  In  the  poorer  classes  of  houses,  where  super- 
vision of  any  closet  arrangements  is  indispensable,  the 
adoption  of  the  earth  system  offers  special  advantages. 

"(4.)  The  earth  system  of  excrement -removal  does 


EEMOVAL  OF  SEWAGE.  317 

not  supersede  the  necessity  for  an  independent  means  of 
removing  slops,  rain-water,  and  soil-water. 

"  (5.)  The  limits  of  application  of  the  earth  system  in 
the  future  cannot  be  stated.  In  existing  towns,  favourably 
arranged  for  access  to  the  closets,  the  system  might  be  at 
once  applied  to  populations  of  10,000  persons. 

"(6.)  As  compared  with  the  water-closet,  the  earth 
system  has  these  advantages : — It  is  cheaper  in  the 
original  cost,  it  requires  less  repair,  it  is  not  injured  by 
frost,  it  is  not  damaged  by  improper  substances  driven 
down  it,  and  it  very  greatly  reduces  the  quantity  of  water 
required  by  each  household." 

The  agricultural  value  of  the  earth  excrement,  its 
facility  of  transport,  and  variety  of  application,  are  also 
pointed  out. 

The  disadvantages  of  the  system  are — the  difficulties 
of  procuring,  drying,  and  storing  the  earth,  particularly  in 
crowded  localities ;  the  special  service  and  attention  which 
the  closets  require ;  the  frequent  discomfort  attending 
their  use  when  the  earth  is  very  dry  and  powdery ;  and 
the  inadequacy  of  the  system  as  a  means  of  removing  the 
whole  excreta  and  slops.  "  Add  to  these  circumstances 
the  enormous  aggravation  of  all  the  difficulties  of  the  plan, 
when  not  50  but  50,000  households  have  to  be  provided 
with  the  necessary  appliances,  and  induced  to  work  them 
properly,  and  we  can  have  no  hesitation  in  pronouncing 
the  dry  earth  system,  however  suitable  for  institutions, 
villages,  and  camps,  where  personal  or  official  regulations 
can  be  enforced,  entirely  unfitted  to  the  circumstances  of 
large  towns." — (First  Eeport  of  the  Rivers  Pollution  Com- 
missioners, 1868.) 

When  the  closets  are  properly  managed,  it  appears 
that  the  faecal  matters  are  disintegrated,  so  that  after  a 
time  no  excrement  whatever  can  be  detected  in  the  mix- 


318  REMOVAL  OF  SEWAGE. 

ture.  After  keeping  and  drying,  therefore,  it  may  be  used 
several  times  without  losing  its  deodorising  and  absorbing 
properties,  but  much  depends  on  the  quality  of  the  earth 
used  at  the  outset.  The  suitability  of  various  soils  is 
given  in  the  following  order: — 1,  rich  garden  mould; 
2,  peaty  soils ;  3,  black  cotton  soils ;  4,  clays ;  5,  stiff 
clayey  loams  ;  6,  red  ferruginous  loams  ;  7,  sandy  loams  ; 
8,  sands. 

For  isolated  buildings  and  small  country  villages, 
where  there  is  no  difficulty  in  obtaining  suitable  earth, 
and  afterwards  disposing  of  it,  and  where  the  necessary 
labour  and  management  can  be  procured,  the  system  is 
almost  perfect. 

The  closets  may  either  be  used  as  fixtures  or  as 
movable  commodes,  the  latter  being  intended  for  use  in 
bed-rooms,  hospital-wards,  etc. 

2:  Various  other  modifications  of  the  dry  system  have 
been  tried  or  proposed,  among  which  may  be  mentioned 
the  Carbon  Disinfecting  and  Deodorising  Closet  of  Messrs. 
Weare  and  Co.,  in  use  in  several  parts  of  Liverpool ;  the 
charcoal  manufactured  from  street  sweepings  by  the  Uni- 
versal Charcoal  and  Sewage  Company,  Limited,  at  Salford  ; 
and  the  charcoal  manufactured  from  seaweed  by  the -Carbon 
Fertiliser  Company  of  Glasgow.  With  regard  to  the  last, 
Mr.  Netten  Radcliffe  observes  that  "the  examination  of 
the  charcoal  closets  in  Glasgow  and  the  vicinity  proves, 
as  was  to  be  anticipated,  that  charcoal  properly  applied 
acts  as  a  most  effective  deodoriser  of  excrement,  and  that 
this  action,  in  receptacles  kept  dry,  persists  for  an  inde- 
finite period.  The  assumption,  however,  that  the  mixed 
excrement  and  charcoal  may  therefore  be  safely  stored  for 
many  months  in  the  vicinity  of  or  within  the  precincts  of 
dwellings,  appears  to  me  to  be  at  least  premature." 

The  carbon  fertilising  process,  as  patented  by  Mr. 
Stanford,  has  recently  been  tried  at  Oldham,  but  only 


REMOVAL  OF  SEWAGE.  319 

witli  varying  success.  It  consists  in  absorbing  excre- 
mentitious  matter  with  charcoal,  and  afterwards  drying 
and  carbonising  the  mixture  ;  thus  producing  a  continually 
increasing  quantity  of  charcoal,  which  may  be  employed 
in  the  manufacture  of  manure,  or  for  other  purposes. 
The  principal  product  of  the  destructive  distillation  is 
ammonia. 

Another  closet  which  works  well,  and  which  has  been 
highly  spoken  of  by  Dr.  Carpenter,  Professor  Corfield,  and 
Lieut-Col.  Hope,  V.C.,  is  the  closet  known  as  the  Moser 
Dry  Closet.  It  is  simple,  automatic,  and  certain  in  its 
action,  and  is  so  constructed  that  any  kind  of  available 
absorbent  material  can  be  used,  such  as  dry  earth,  road 
dust,  powdered  charcoal,  sawdust,  etc.,  and  either  with  or 
without  the  addition  of  chemical  disinfectants. 

Although  other  appliances  might  be  enumerated  in 
connection  with  the  dry  system,  it  will  be  sufficient  to 
point  out  that  without  proper  care  and  supervision  this 
system  possesses  no  special  advantages  over  the  ordinary 
pail  system. 

With  respect  to  the  various  systems  already  referred 
to,  the  Committee  on  Sewage  Disposal  reported  that  "  the 
attempts  to  economise  in  town-sewering  and  scavenging 
by  removing  human  excreta  separately  has  been  a  failure, 
the  local  costs  have  been  increased,  and  the  local  nuisances 
also,  in  proportion  to  the  time  of  retention  of  the  excreta 
before  removal ;  there  is  also  the  inconvenience  suffered 
by  trespass  on  the  privacy  of  the  household." 

SECTION  V. — LIEURNUR'S  AND  OTHER  CONTINENTAL 
SYSTEMS. 


These  need  only  require  brief  mention.  Captain 
Lieurnur's  system  may  be  described  as  consisting  of  air- 
tight iron  tanks  situated  under  the  streets,  which  are 


320  REMOVAL  OF  SEWAGE. 

connected  by  iron  pipes  with  the  closets  in  the  houses. 
By  means  of  a  powerful  air-pump  worked  by  steam  the 
sewage  is  sucked  along  the  pipes  to  these  central  tanks, 
and  is  afterwards  converted  into  poudrette.  Only  a  little 
water  is  used  in  the  closets.  The  system  has  been  tried 
in  Amsterdam,  Leyden,  and  elsewhere  ;  but,  owing  in  great 
measure  to  its  original  cost,  it  has  not  met  with  much 
acceptance.  Moreover,  it  appears  to  be  radically  defective 
in  principle,  because  it  is  evident  that  the  pipes  must 
become  clogged  up  sooner  or  later  with  fsecal  matter,  and 
indeed  this  result  is  not  at  all  unusual.  According  to  the 
Seventh  Eeport  of  the  State  Board  of  Health  of  Massa- 
chusetts there  is  great  complaint  of  the  bad  odour  from 
the  closets  when  they  are  situated  inside  houses,  and  in 
order  to  obviate  this  nuisance,  the  people  are  in  the  habit 
of  flushing  them  with  large  quantities  of  water.  The 
consequence  is  that  the  sewage  becomes  so  much  diluted 
that  it  could  only  be  converted  into  poudrette  at  a  most 
ruinous  cost. 

The  fosses  permanentes  of  Paris,  Brussels,  and  other 
continental  towns,  are  huge  j)its,  placed  generally  under 
courtyards.  They  are  lined  with  cement,  so  as  to  render 
them  impervious,  and  are  usually  ventilated  by  shafts 
rising  some  feet  above  the  roofs  of  the  houses.  The  con- 
tents are  removed  three  or  four  times  during  the  course 
of  the  year  by  air-tight  carts  (tonneaux),  from  which  the 
air  is  exhausted  previous  to  filling,  so  that  the  sewage  is 
forced  into  them  through  a  hose  by  atmospheric  pressure. 
The  closets  in  connection  with  the  cesspools  are  almost 
invariably  in  a  filthy  state,  from  the  habit  of  standing  on 
the  seat,  which  appears  to  be  prevalent  in  private  houses 
as  well  as  in  public  places. 

The  system  known  as  fosses  mobiles  is  now  adopted  in 
many  continental  towns,  and  is  a  great  improvement  on 
the  system  of  fosses  permanentes.  The  fosse  mobile  is  a 


KEMOVAL  OF  SEWAGE.  321 

closed  tub  placed  on  a  stand  with  wheels,  and  connected 
by  a  descent-pipe  with  the  different  closets  or  faiences  of 
a  house.  When  filled  it  is  replaced  by  another  of  the 
same  construction.  The  alfuhrtonnen  of  the  Germans  are 
of  a  similar  description,  but  in  many  of  the  larger  towns 
the  bucket  or  pail  under  the  privy  seat  is  used  (Berlin, 
Leipsic,  etc.) 

SECTION  VI. — SYSTEMS  BEST  SUITED  FOR  EURAL 
DISTRICTS. 

In  villages  where  the  scavenging  is  undertaken  by 
the  Sanitary  Authority,  it  is  just  as  essential  that  some 
uniform  scheme  of  excrement-disposal  should  be  adopted 
as  in  towns,  but  in  the  great  majority  of  country  villages 
provided  with  sufficient  garden  space,  public  scavenging 
is  not  necessary,  because  the  solid  refuse  can  generally  be 
safely  disposed  of  on  the  premises.  The  kind  of  altera- 
tions, therefore,  which  may  be  required  to  remove  privy 
nuisance,  will  depend  very  much  upon  existing  arrange- 
ments. If,  for  example,  the  privy  abuts  against  the  house, 
or  is  not  very  far  from  a  well,  it  should  either  be  removed 
altogether,  or  be  converted  into  an  earth  or  ash  closet, 
and  be  provided  with  a  box  or  pail  to  receive  the  excreta. 
"  Inside  a  house,"  as  I  have  said  elsewhere,  "  the  only  .  . 
kind  of  closet  which  can  be  used  without  risk  to  health  \ 
must  be  a  water-closet  communicating  with  a  drain  or 
cesspool,  or  a  dry  closet  of  an  approved  pattern ;  but  in 
either  case  the  closet  must  be  detached  from  any  living 
or  sleeping  room,  and  be  properly  ventilated.  In  country, 
villages,  however,  the  closet  accommodation,  except  in  a 
few  of  the  better  class  houses,  is  situated  outside,  and  is 
of  every  conceivable  description.  In  the  older  villages  it 
is  sometimes  represented  by  a  rough  wooden  erection, 
with  a  hole  dug  in  the  ground  to  receive  the  excreta,  or 

Y 


322  REMOVAL  OF  SEWAGE. 

more  frequently  by  a  sentry-box-looking  structure,  stuck 
somewhere  near  the  far  end  of  the  garden,  and  with  a 
stinking  leaky  cesspit  behind.  In  more  modern  villages, 
however,  the  privy  and  ashpit  or  middenstead  are  found 
combined ;  but  as  a  rule  the  ashpit  is  large  and  deep,  leaky 
and  uncovered,  so  that  at  all  times  it  is  more  or  less  of  a 
nuisance.  Then,  again,  in  the  few  best  class  houses  pro- 
vided with  water-closets,  it  is  generally  found  that  the 
soil-pipe  is  not  ventilated,  and  that  the  closet  discharges 
either  into  a  covered  cesspool,  from  which  any  gases 
generated  can  escape  only  into  the  house,  or  into  a  village- 
drain  which  was  not  constructed  to  receive  excremental 
filth.  Such,  briefly,  are  some  of  the  more  common 
varieties  of  closet -accommodation  to  be  met  with  in 
country  villages,  and  I  need  hardly  say  that  the  structural 
defects  connected  with  them  are  very  often  a  source  of 
nuisance  and  risk  to  health.  How,  then,  are  these  defects 
to  be  remedied,  legally,  in  the  first  place,  and  with  a  due 
regard  at  all  times  to  efficiency  and  cost  ?  Take,  for  ex- 
ample, the  primitive  wooden  structure,  with  the  hole  dug 
in  the  ground  to  receive  the  excreta.  As  a  rule,  this  kind 
of  privy-accommodation  is  only  met  with  when  the  cottage 
itself  is  old  and  dilapidated,  so  that  it  would  be  a  sheer 
waste  of  money  to  insist  on  the  erection  of  a  new  and 
substantial  structure.  All  that  the  law  demands  is  to 
fairly  satisfy  the  requirements  of  health  and  decency,  and 
this  can  be  accomplished  in  the  great  majority  of  instances 
at  a  very  trifling  outlay.  Let  the  whole  be  cleaned  out 
and  filled  in  with  fresh  gravel  or  clay,  and  such  other 
.  alterations  made  that  a  galvanised  iron  pail  or  box  can  be 
readily  inserted  beneath  the  seat  to  receive  the  excreta. 
This,  of  course,  should  be  regularly  emptied  into  the 
garden  ;  and  to  obviate  nuisance,  dry  earth  or  sifted  ashes 
should  be  thrown  into  the  pail  at  least  once  a  day,  and  in 
sufficient  quantity  to  keep  the  excreta  covered.  If  the 


REMOVAL  OF  SEWAGE.  323 

seat  is  hinged,  there  will  be  no  difficulty  in  removing  the 
pail  or  in  throwing  the  ashes  into  it  without  dirtying  the 
seat.  Or  take  the  old-fashioned  privy,  with  its  foetid 
cesspit  behind.  This  can  be  readily  converted  into  an 
inoffensive  privy  and  ashpit  combined,  by  filling  up  the 
cesspit  to  the  level  of  the  ground ;  paving  or  cementing 
the  filled  area,  walling  it  in,  and  covering  it  as  an  ashpit ; 
raising  the  floor  of  the  privy  a  step,  and  with  it  the  seat ; 
and  placing  a  flag  sloping  backwards  beneath  the  seat,  so 
that  the  excreta  may  be  readily  covered  with  the  sifted 
ashes  or  dry  refuse  thrown  into  the  ashpit.  Or  the  ash- 
pit may  be  dispensed  with,  and,  after  filling  up  the  cess- 
pit, the  privy  may  be  readily  converted  into  a  pail-closet. 
To  sift  the  ashes,  either  a  common  riddle  may  be  used, 
or  such  cinder-sifters  as  those  devised  by  Dr.  Bond  of 
Gloucester,  and  Mr.  Fox  of  Cockermouth.  But  whatever 
alterations  may  be  adopted  in  addition  to  those  required 
for  privacy  and  ventilation,  the  great  desideratum  is  to 
keep  the  excreta  dry,  and  prevent  undue  accumulation. 
Large,  deep,  and  uncovered  middensteads,  or  ashpits 
connected  with  privies,  are  always  a  source  of  nuisance. 
When  they  are  nearly  empty,  the  surrounding  soil  drains 
into  them  in  wet  weather,  so  that  for  the  time  being  they 
become  open  offensive  cesspools,  and  when  full  they  permit 
of  soakage  into  the  surrounding  soil.  Every  ashpit,  there- 
fore, connected  with  a  privy  should  be  little,  if  at  all 
below  the  level  of  the  ground ;  it  should  be  cemented,  or 
made  otherwise  water-tight,  and  should  be  covered  (a 
sloping  tarred  wooden  covering  hooked  on  to  the  back  of 
the  privy  will  do),  to  keep  out  the  rain.  Moreover,  it 
should  be  of  limited  capacity,  to  prevent  undue  accumu- 
lation, and  thereby  necessitate  frequent  removal  of  the 
contents.  Sometimes,  in  order  to  keep  the  contents  more 
or  less  dry,  the  ashpit  is  drained ;  but  apart  from  the 
liability  to  chokage  of  the  drain,  and  the  nuisance  arising 


324  REMOVAL  OF  SEWAGE. 

from  the  admission  of  liquid  excremental  filth,  drainage 
of  the  ashpit  should  be  prohibited,  because,  if  the  ashes 
do  not  keep  the  excreta  dry  and  inoffensive,  the  system 
is  a  failure." 

"  From  these  few  remarks  it  will  be  observed  that  I 
advocate  every  possible  latitude  as  regards  the  way  in 
which  nuisances  connected  with  privy  accommodation 
may  be  removed.  In  villages,  however,  for  which  public 
scavenging  is  considered  necessary,  there  is  no  doubt  that 
some  uniformity  in  the  nature  of  the  alterations  must  be 
carried  out,  and  I  am  of  opinion  that  one  or  other  of  the 
pail  systems  would  answer  best;  as,  for  example,  the 
Goux  system.  In  rural  districts,  provided  with  urban 
powers,  the  kind  of  privy-accommodation  supplied  for  new 
houses  should  be  carefully  considered  and  enforced ;  and 
in  one  of  my  own  districts  I  may  mention  that  the  closet 
known  as  Moser's  closet  is  the  one  approved  by  the  Sani- 
tary Authority,  although  I  need  hardly  say  there  are  many 
other  patents  which  would  answer  equally  well.  Indeed, 
for  new  houses  any  patent  of  the  kind  is  much  cheaper 
than  the  old-fashioned  privy  with  its  huge  deep  ashpit, 
and,  what  is  more,  it  is  a  sure  preventive  against  any 
serious  nuisance.  But  for  old-fashioned  country  villages, 
where  alterations  of  a  limited  kind  have  to  be  carried  out, 
I  do  not  think  that  any  of  the  excellent  patents  to  which 
I  have  referred  are  suitable,  partly  because  they  are  some- 
what expensive,  and  partly,  too,  because  I  find  that  from 
neglect  they  do  not  afford  any  advantages  over  the  ordi- 
nary pail-system.  In  short,  there  is  no  dearth  either  of 
adequate  appliances  or  material  ready  at  hand  to  answer 
all  reasonable  sanitary  requirements,  if  we  could  only  get 
people  to  make  proper  use  of  them." — (See  the  Author's 
pamphlet  on  Sanitary  Defects  in  Rural  Districts,  and  how 
to  remedy  them.) 


REMOVAL  OF  SEWAGE.  325 

SECTION  VII. — DISPOSAL  OF  SLOPS. 

The  term  slop  -  water,  as  commonly  understood,  is 
used  to  indicate  ordinary  household  liquid  refuse  ex- 
clusive of  faecal  matter.  For  the  most  part  it  consists 
of  urine,  soap-suds,  and  the  foul  washings  from  premises 
generally ;  and  though  it  may  not  be  considered  as 
offensive  as  town -sewage,  it  frequently  gives  rise  to 
serious  nuisance  when  it  is  allowed  to  fester  in  rubble 
drains  or  stagnant  ditches,  and  is  a  constant  cause  of 
well-pollution  in  country  districts.  In  all  sewered  towns 
the  slops  are  of  course  removed  by  the  ordinary  drains 
and  sewers,  and  even  in  most  villages  it  is  fonnd  that 
their  disposal  is  in  great  measure  a  question  of  village- 
drainage  in  the  first  instance.  But,  unfortunately,  this 
village-drainage  is  so  radically  defective  in  the  great 
majority  of  instances,  that  pollution  of  air  and  water  is 
alike  common.  The  shallow  road  drains  which  were 
intended,  when  first  laid  down,  to  carry  off  the  surface 
water,  and  which,  for  the  most  part,  are  generally  con- 
structed of  common  drain  pipes,  or  loosely  laid  bricks  or 
stones,  have  been  converted  into  common  sewers  by 
conveying  into  them  the  badly  laid  and  open -jointed 
drains  leading  from  almost  every  house,  or  group  of 
houses,  in  the  village.  If  there  be  a  watercourse  near 
the  village  the  drainage  discharges  into  the  stream  by 
one  or  several  outlets,  as  the  case  may  be,  and  with  what 
results  it  is  needless  to  specify.  Should  it  happen,  how- 
ever, that  the  village  is  some  distance  from  a  stream, 
then  it  is  found  that  the  slops  discharge  into  open 
ditches  by  the  roadside,  or  into  field-ditches  in  the 
immediate  neighbourhood  of  houses,  and  thereby  often 
give  rise  to  filthy  nuisances  in  every  direction.  This 
description,  it  is  true,  only  applies  to  the  worst  drained 
villages ;  but  in  almost  all  of  them  some  of  these  defects 


326  KEMOVAL  OF  SEWAGE. 

are  to  be  met  with.  Shallow,  unevenly  laid,  and  leaky 
drains  are  especially  common ;  and  as  these  are  not  only 
liable  to  pollute  any  wells  which  may  be  near  them,  but 
in  consequence  of  the  want  of  proper  means  of  flush- 
ing permit  of  filth-accumulations,  which  give  off  noxious 
effluvia,  they  are  a  source  of  constant  danger. 

And  this  description,  it  should  be  remembered,  ap- 
plies to  villages  in  which  water-closets  do  not  exist  at 
all,  or  are  very  rare,  so  that  the  whole  of  the  nuisance 
may  be  said  to  depend  upon  the  disposal  of  the  slop- 
water.  The  question,  therefore,  at  once  arises  whether 
in  any  given  case  a  new  system  of  drainage  will  be 
required,  or  the  existing  system  improved  to  remove 
nuisance,  or  whether  the  slops  cannot  be  satisfactorily 
disposed  of  in  some  other  way.  If  common  gutters,  as 
some  recommend,  are  to  take  the  place  of  drains,  it  is 
clear  that  all  the  old  defective  drains  must  first  be  taken 
up  and  filled  in  with  sound  material,  and  that  the  gutters 
themselves  should  be  properly  channelled  and  kept  clean. 
But  in  the  present  condition  of  village-roads,  with  badly- 
laid  side-paths,  it  is  just  as  evident  that  these  open 
gutters  would  be  a  constant  source  of  nuisance,  and 
hence,  in  compact  villages,  or  villages  of  any  size,  the 
question  of  the  disposal  of  slops,  is,  as  I  have  already 
said,  a  question  of  drainage,  and  need  not  be  further  dis- 
cussed here.  It  is  sufficient  to  state  that  all  such  drains 
ought  to  be  well  laid,  well  ventilated,  and  kept  properly 
flushed,  especially  in  warm  weather,  by  means  of  a  hand 
water-cart,  which  could  be  easily  wheeled  about  by  the 
road-man.  (For  further  remarks,  see  next  chapter.) 

As  regards  scattered  houses,  or  -groups  of  houses 
which  create  nuisance  by  draining  into  open  roadside 
ditches,  such  nuisance  may  be  obviated  by  using  the 
slops  in  the  garden,  and  if  there  be  not  sufficient  garden 
space,  I  know  of  no  better  mode  of  dealing  with  them 


REMOVAL  OF  SEWAGE.  327 

than  that  devised  by  Dr.  Bond,  which  consists  in  the  use 
of  a  precipitating  slop-tub  with  a  filter.  Where  there  is 
sufficient  garden  space,  and  the  ground  slopes  away  from 
the  house,  the  most  satisfactory  way  of  treating  them  is 
by  sub-irrigation,  and  the  use  of  Field's  syphon  flush- 
tank,  but  care  must  be  taken  that  the  sub-irrigation 
drains  are  laid  at  a  safe  distance  from  the  well.  Some- 
times the  drains  lead  into  what  is  called  a  dumb-well ; 
and  provided  there  is  no  well  for  drinking-water  near, 
and  the  dumb:well  is  ventilated  and  regularly  cleaned 
out,  this  may  be  regarded  as  a  tolerably  safe  and  ready 
method  of  dealing  with  the  difficulty.  But  the  multipli- 
cation of  dumb-wells  or  cesspools  in  villages,  as  in  towns, 
is  always  attended  with  danger,  and  ought  to  be  avoided 
as  much  as  possible. 

SECTION  VIII. — PUBLIC  SCAVENGING. 

Except  it  be  in  small  scattered  communities,  and 
perhaps  purely  agricultural  villages,  it  may  be  laid  down 
as  a  rule  that  no  semblance  of  local  cleanliness  can  be 
maintained  unless  the  scavenging,  as  well  as  the  sewerage, 
be  undertaken  by  the  Sanitary  Authorities ;  for,  in  pro- 
portion as  dwellings  become  aggregated,  and  populations 
increase,  it  becomes  more  and  more  difficult  for  individual 
householders  to  dispose  of  their  refuse  separately.  Fortu- 
nately, in  the  great  majority  of  agricultural  villages  there 
is  sufficient  garden  space  attached  to  the  houses  to  permit 
at  all  events  of  the  safe  disposal  of  the  solid  refuse  on 
the  premises  without  creating  nuisance,  or  for  exceptional 
cases  there  need  be  little  difficulty  in  arranging  for  its 
disposal  on  some  closely  adjacent  land.  Arrangements, 
for  example,  may  generally  be  made  with  some  neighbour- 
ing farmer,  or,  as  Mr.  Haviland  has  suggested,  any  excep- 
tional difficulties  which  may  arise,  from  want  of  sufficient 


328  REMOVAL  OF  SEWAGE. 

garden  space  might  be  overcome  if  Sanitary  Authorities 
were  to  provide  a  spare  corner  of  ground,  known  as  "  the 
muck  acre"  to  which  householders  could  remove  their 
solid  refuse.  But  whenever,  in  any  village  or  town,  these 
difficulties  are  ascertained  to  be  at  all  common,  it  then 
becomes  the  duty  of  the  Sanitary  Authority  of  the  dis- 
trict to  undertake  the  efficient  scavenging  of  premises, 
either  through  their  own  officers  or  by  contract,  and  in 
case  of  refusal  or  neglect,  they  can  be  compelled  to  do  so 
by  order  of  the  Local  Government  Board.  In  any  case, 
however,  the  Sanitary  Authority  is  virtually  responsible 
for  the  cleanliness  of  its  district,  either  by  enforcing  the 
provisions  of  the  Public  Health  Act  for  the  prevention  of 
nuisance  arising  from  filth-accumulation  on  individual 
premises  in  places  to  which  scavenging  does  not  extend, 
or  by  systematically  preventing  the  occurrence  of  nuisance 
in  places  where  public  scavenging  has  been  introduced. 

As  regards  the  general  details  of  public  scavenging, 
much  will  depend  upon  local  circumstances,  and  upon 
the  method  of  excretal  removal  which  may  be  found  to 
prevail  in  any  particular  town.  Where  the  old-fashioned 
midden  system  is  still  allowed  to  be  carried  on,  the  house- 
refuse  is  mixed  with  the  excreta,  and  both  are  carted 
away  together.  In  the  majority  of  towns,  however,  the 
ashes  and  other  solid  house-refuse  must  be  collected  and 
removed  by  a  separate  system,  which  necessitates  the  use 
of  dust  pails  or  bins,  and  the  daily  or  frequent  visit  of 
the  scavenger's  cart.  For  dwellings  occupied  by  single 
families  the  dust  box  or  pail  answers  very  well,  it  being 
large  enough  to  contain  the  dry  refuse  collected  during 
the  twenty-four  hours  ;  and  as  it  is  emptied  into  the 
scavenger's  cart  at  a  stated  time  daily,  any  accumulation 
about  the  premises  is  prevented.  But  in  crowded  parts, 
where  families  live  in  separate  tenements,  the  whole  of 
the  ashes  and  dry  refuse  is  usually,  in  the  first  instance, 


REMOVAL  OF  SEWAGE.  329 

emptied  into  a  common  dust-bin,  and  afterwards  carted 
away  when  the  bin  becomes  full.  In  this  case  it  is 
necessary  that  the  bin  should  be  roofed  in,  in  order  to 
keep  the  contents  dry,  and  that  it  should  be  well  ven- 
tilated. No  slops  or  excrement  should  be  allowed  to  be 
thrown  into  it,  because  the  former  excite  fermentation  in 
the  vegetable  and  animal  matters  contained  in  the  refuse, 
and  the  latter  renders  the  contents  offensive.  It  need 
scarcely  be  added  that,  in  a  sanitary  point  of  view,  dust- 
bins should  be  frequently  and  regularly  emptied. 

In  large  towns  where  the  pail  system  of  excreta! 
removal  is  carried  out,  the  excrement -pails  should  be 
removed  in  specially  covered  vans,  and  the  ashes  and 
dry  house-refuse  in  separate  carts.  The  following  is  Mr. 
Netten  Kadcliffe's  description  of  the  system  of  scavenging 
as  carried  on  at  Eochdale : — 

"  The  town  is  divided  into  six  districts  for  the  pur- 
poses of  removal,  and  the  dry  house  refuse  is  removed  at  // 
the  same  time  as  the  excrement,  a  dust-cart  accompany-  f 
ing  each  night-soil  van  for  the  purpose.  The  removal  is 
all  effected  during  the  ordinary  working  hours  of  the 
day,  the  vans  commencing  their  rounds  at  7.0  am.,  and 
ending  at  5.30  p.m.  Each  night-soil  van  makes  five 
rounds  daily.  It  leaves  the  yard  laden  with  clean  empty 
pails,  each  pail  containing  a  quantity  of  a  '  disinfectant/ 
and  returns  carrying  the  pails  containing  excrement,  for 
which  the  empty  pails  have  been  substituted.  The  pro- 
cess of  substitution  is  effected  by  the  scavengers  with- 
drawing from  beneath  the  closet  seat  the  pail  containing 
excrement,  covering  this  up  with  the  lids  already  de- 
scribed, removing  it  to  the  van,  an  empty  pail  being  left 
in  its  place,  and  on  placing  the  pail  in  the  van  sprinkling 
over  the  outer  lid  a  little  carbolate  of  lime.  The  ash- 
tub  is  then  carried  to  the  dust-cart,  and  its  contents 
simply  tilted  into  it.  Each  pail  closet  is  numbered  and 


330  REMOVAL  OF  SEWAGE. 

registered,  and  the  scavengers  proceed  from  closet  to 
closet  systematically,  according  to  the  portion  of  their 
district  within  the  day's  beat,  revisiting  at  the  end  of 
each  round  the  closets  from  which  the  pails  had  been 
removed,  and  those,  if  any,  which  had  been  omitted. 
The  greatest  number  of  omissions  for  any  one  month  in 
the  whole  town  has  been  42,  for  any  one  week  14. 
Each  Monday  the  scavenger's  returns  are  balanced,  and 
a  supplementary  van  with  dust-cart  sent  out  to  rectify 
omissions.  In  the  case  of  lodging-houses  and  closets 
used  by  several  families  the  excrement-pails  are  removed 
twice  or  thrice  weekly." 

In  scavenging  old-fashioned  midden-steads  and  privies, 
the  nuisance  is  so  abominable  that  the  soil-cart  can  only 
make  its  rounds  during  the  night-time,  and  even  then  the 
stench  is  so  horrible  that  the  air  of  every  street  or  court 
along  which  the  cart  passes  becomes  for  the  time  being 
positively  dangerous  to  breathe.  People  who  are  out  late 
at  night  may  sniff  these  carts  a  long  way  off,  and  when 
they  do  so  they  generally  beat  a  hasty  retreat. 

One  very  important  branch  of  scavenging  in  urban 
districts  is  directed  to  the  cleaning  of  streets  and  back 
courts,  many  of  which  are  so  badly  constructed  that  it 
is  next  to  impossible  to  prevent  filth -accumulations. 
Gutters  are  often  so  unevenly  laid,  that  after  rain  or 
flushing  there  are  small  stagnant  pools  to  be  seen 
throughout  their  whole  extent.  The  surfaces  of  maca- 
damised streets,  again,  are  being  constantly  pulverised, 
and  give  off  clouds  of  dust  containing  large  quantities  of 
decomposing  animal  and  vegetable  matter  in  dry  weather, 
or  are  covered  with  liquid  mud  when  it  is  wet ;  while 
paved  streets  present  numerous  interstices,  which  cannot 
be  efficiently  cleaned  out  even  when  scrubbing-machines 
and  flushing  are  both  used.  There  is  no  doubt,  therefore, 
that  the  new  plan  of  street  construction  which  has  lately 


REMOVAL  OF  SEWAGE.  331 

been  introduced  into  some  parts  of  London  and  other 
large  towns,  whether  it  be  wood-pavement  or  asphalt, 
and  preferably  the  former,  will  not  only  prove  to  be 
economical  in  many  ways,  but  will  also  be  productive  of 
great  sanitary  advantages.  Tar-asphalt,  if  properly  laid, 
is  especially  applicable  to  side  paths,  back  courts,  and 
narrow  streets,  where  the  traffic  is  inconsiderable,  because 
it  is  cheap,  durable,  non-absorbent,  and  washable. 


332         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 


CHAPTEK    XII. 

PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

IT  has  already  been  shown,  in  the  previous  chapter,  that 
of  all  methods  of  sewage -removal,  the  water-carriage 
system  is  the  one  which  best  meets  the  requirements  of 
large  towns.  It  is  the  speediest,  cleanest,  and,  in  the 
long  run,  the  most  economical,  method  which  can  be 
employed  on  an  extensive  scale,  and  its  general  sanitary 
advantages  are  now  placed  beyond  dispute.  But  no 
sooner  had  this  difficult  hygienic  problem  been  solved  by 
engineering  skill  than  another  of  even  greater  difficulty 
arose.  The  eagerness  of  early  sanitary  reformers  to  get 
rid  of  human  refuse  at  any  cost  blinded  them  to  the  fact 
that,  by  pouring  sewage  into  the  nearest  watercourse, 
they  were  merely  removing  the  evil  from  one  place  to 
take  effect  somewhere  else.  No  consideration  was  paid 
to  the  probable  results  of  the  method  on  the  future  water- 
supply  of  increasing  populations,  nor  to  other  serious  con- 
sequences which  speedily  began  to  declare  themselves. 
Rivers  were  in  reality  converted  into  sewers,  and  the 
communities  down  stream,  while  they  loudly  complained 
of  the  annoyance  and  danger  to  health,  added  to  the 
nuisance  by  following  the  general  example.  After  a 
time  it  was  discovered  that  the  mouths  of  navigable 
rivers  were  being  silted  up,  that  valuable  stocks  of  fish 
were  destroyed,  that  water-supplies  were  contaminated, 
and  that  riparian  rights  were  in  every  sense  grossly 
violated.  Such  were  some  of  the  more  important  evils 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.         333 

resulting  from  river-pollution,  and  eventually  legal  prohi- 
bitions were  issued  in  many  places  to  prevent  their  con- 
tinuance. These  prohibitions  have  multiplied,  until  the 
sanitary  authorities  throughout  the  country  are  at  last 
compelled  to  purify  the  sewage  of  towns  before  it  is  dis- 
charged into  any  watercourse  at  a  distance  from  the  sea, 
or  run  the  risk  of  incurring  legal  penalties ;  while  the 
Eivers  Pollution  Act  of  1876  absolutely  prohibits  any 
new  drainage- works  which  may  in  future  be  carried  out 
from  discharging  into  any  river  or  stream  without  pre- 
vious purification. 

Meanwhile  there  has  been  an  increasing  number  of 
economists  who  have  rightly  maintained  that  sewage  was 
not  only  wasted,  but  worse  than  wasted,  when  discharged 
into  rivers,  and  that,  on  account  of  its  manurial  value,  its 
proper  destination  was  the  soil.  Hence  has  risen  the 
larger  question  of  the  utilisation  of  sewage,  the  merits  of 
which  will  be  best  understood  by  considering  first  the 
composition  of  town-sewage. 

SECTION  I. — TOWN-SEWAGE. 

In  addition  to  excretal  matters,  town-sewage  contains 
the  effete  products  of  various  trades  and  manufactures, 
animal  and  vegetable  dtbris,  mineral  detritus  from  roads 
and  streets,  and  the  like,  all  of  which  are  held  in  suspen- 
sion or  solution  by  an  amount  of  water  varying  according 
to  the  water-supply  in  the  first  instance,  and  depending, 
in  the  second  place,  on  the  rainfall  and  amount  of  sub- 
soil-water entering  the  sewers  at  different  times  of  the 
year.  This  varyiug  amount  of  water  is  one  of  the  chief 
difficulties  to  be  encountered  in  the  utilisation  of  sewage, 
and,  apart  from  other  considerations,  it  has  led  Mr.  Men- 
zies  and  other  eminent  engineers  to  recommend  the  intro- 
duction of  the  pipe-sewer  system,  which  has  already  been 
described,  into  all  towns  where  sewerage-plans  have  yet  to 


334          PURIFICATION  AND  UTILISATION  OF  SEWAGE. 


be  carried  out.  The  sewage  delivered  from  pipe-sewers, 
consisting  almost  exclusively  of  excretal  matters,  slops, 
and  the  water-supply,  can  of  course  be  readily  estimated 
in  all  cases,  and  is  much  more  easily  dealt  with.  But 
with  common  drain-sewers,  which  receive  in  addition  the 
rainfall  and  subsoil- water,  not  only  is  the  extent  of  dilu- 
tion much  greater,  but  it  is  constantly  varying  in  amount. 
Thus,  to  quote  the  data  given  in  the  Third  Eeport  of 
the  Sewage  of  Towns  Commissioners  (1865),  it  is  con- 
sidered that  6  0  tons  per  head  per  annum  (  =  36  gallons 
per  head  daily)  is  the  average  amount  of  normal  or  dry- 
weather  sewage  in  the  metropolis ;  but  this  amount  is 
further  increased  by  the  rainfall  and  subsoil-water  from 
two-thirds  to  an  equal  volume.  With  pipe-sewers,  however, 
the  amount  of  sewage  equals  the  amount  of  water-supply, 
and  in  towns  supplied  on  the  constant  system,  this  ought  not 
to  exceed  20  gallons  per  head  daily,  or  about  33  tons  per 
head  per  annum.  In  the  face  of  such  considerations  as  these, 
the  sanitary  and  practical  importance  of  Mr.  F.  0.  Ward's 
famous  alliterative  dogma  of  "the  rainfall  to  the  river, 
and  the  sewage  to  the  soil,"  becomes  at  once  apparent. 

But,  with  either  system  of  sewers,  the  value  of  the 
sewage  may  be  said  to  depend  entirely  on  the  excretal 
matters,  and  the  amount  and  relative  value  of  these  will 
be  gathered  from  the  following  data : — 

The  subjoined  table  represents,  as  the  result  of 
numerous  analyses,  the  average  amount  and  composition 
of  excretal  matter  discharged  by  a  male  adult  daily : — 


Fresh 
Excrements. 

Dry 

Substances. 

Mineral 
Matter. 

Carbon. 

Nitrogen. 

Phosphates. 

Faeces 
Urine 

Oz. 

4-17 
46-01 

Oz. 

1-041 
1735 

Oz. 
0-116 
0-527 

Oz. 
0-443 
0-539 

Oz. 

0-053 
0-478 

Oz. 
0-068 
0-189 

Total 

5018 

2776 

0-643 

0-982 

0-531 

0-257 

PURIFICATION  AND  UTILISATION  OF  SEWAGE.         335 

In  a  mixed  population,  the  actual  amounts  per  indi- 
vidual will  obviously  be  considerably  below  this  average, 
and,  according  to  Dr.  Parkes,  they  may  be  estimated  at 
2J  oz.  faecal  matter  and  40  oz.  urine  daily,  an  estimate 
which  gives  25  tons  solid  fseces  for  every  thousand  in- 
habitants annually,  and  91,250  gallons  of  urine.  But 
the  above  table  also  shows  that  the  manurial  value  of  the 
urine  voided  in  the  twenty-four  hours  greatly  exceeds 
that  of  the  fasces  passed  in  the  same  time.  Indeed,  the 
relative  value,  as  determined  by  numerous  analysts,  is 
approximately  as  6  to  1. 

The  actual  value  of  both  urine  and  faeces  in  sewage 
has  been  estimated  at  6s.  8d.  per  individual  per  annum, 
supposing  that  10  Ibs.  of  ammonia  is  a  fair  estimate  of 
the  amount  voided  in  that  time.  When  the  sewage 
averages  24  gallons  daily  per  individual — that  is,  40 
tons  per  head  per  annum — its  money  value,  according  to 
this  estimate,  would  be  2d.  per  ton,  and  the  value  per 
ton  will  decrease  in  proportion  to  the  rate  of  dilution 
above  this  average.  It  may  be  added  that  this  estimate 
corresponds  very  closely  with  the  money  value  of  average 
sewage  given  in  the  First  Eeport  of  the  Eivers  Pollution 
Commissioners  (1868);  for  it  is  there  stated  that  the 
"  value  of  the  dissolved  constituents  in  100  tons  of  average 
sewage  is  about  15s.,  while  the  suspended  matters  only 
contain  about  2s.  worth  of  them."  In  other  words,  100 
tons  are  worth  l*7s.,  or  about  2d.  per  ton. 

These  monetary  details  are  quoted  here  because  they 
largely  affect  the  question  of  utilisation  of  sewage,  and 
have  more  or  less  influenced  the  various  plans  which  have 
been  proposed  or  carried  out  in  this  direction. 


336         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 


SECTION  II. — SCHEMES  FOR  THE  PURIFICATION 
AND  UTILISATION  OF  SEWAGE. 

These  have  generally  been  classified  under  the  sepa- 
rate headings  of  precipitation,  nitration,  and  irrigation 
processes,  and  the  more  important  of  them  are  as  fol- 
lows :— 

1.  Precipitation  processes. — In  all  of  these  processes 
the  main  object  in  view  is  the  purification  of  sewage  by 
the    introduction    of    chemical    agents.      The    dissolved 
matters  are  precipitated  to  a  greater  or  less  extent,  and 
can   therefore   be   separated   along   with   the    suspended 
matters,  while  the  effluent  water  is  supposed  to  be  in  a 
sufficiently  pure  state  to  allow  of  its  being  discharged  into 
a  stream  or  river  without  producing  any  serious  degree 
of  pollution.     It  is  needless  to  say  that  many  of  them 
have  proved  to  be  signal  failures,  chemically  as  well  as 
financially.     Fictitious  values 'were  given  to  the  resulting 
manure,  and  some  of  the  schemes,  which  otherwise  might 
have  proved  fairly   successful,  were   simply   ruined    by 
being    made    stock -exchange    speculations.       Indeed,    it 
cannot  be  too  widely  known  that,  no  matter  what  pro- 
cess may  be  adopted,  Sanitary  Authorities  must  be  pre- 
pared to  pay  a  subsidy  for  the  chemical   treatment   of 
their  sewage,  because  it  is  now  clearly  established  that 
the  manure,  or  whatever  other  products  may  be  obtained, 
will  in  no  case  pay,  or  nearly  pay,  for  the  cost  of  purifi- 
cation.     Several  of  the  following   processes   have   been 
tried  and  failed,  while  others  are  still  on  trial,  and  they 
are  given  here  rather  to  show  what  has  been  attempted 
in  this  direction,  than  as  selected  instances  of  success  or 
failure : — 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.          337 

(1.)  Precipitation  ly  Lime. — This  process  was  at  one 
time  carried  out  on  an  extensive  scale  at  Blackburn, 
Leicester,  and  Tottenham.  It  consists  in  mixing  the 
sewage  at  the  outfall  works  with  a  certain  proportion  of 
cream  of  lime,  when  a  copious  precipitate  takes  place, 
which  may  be  sold  as  manure  or  converted  into  bricks. 
The  supernatant  fluid  flows  off  in  a  comparatively  clear 
though  milky  condition,  but  contains  about  half  the 
putrescible  matter  of  the  sewage, -and  a  great  proportion 
of  the  fertilising  constituents.  The  plan  has  been  pro- 
nounced by  the  Eivers  Pollution  Commissioners  to  be  a 
conspicuous  failure,  "  whether  as  regards  the  manufacture 
of  valuable  manure,  or  the  purification  of  the  offensive 
liquid." 

At  Northampton  a  modification  of  this  process,  by 
the  addition  of  iron  perchloride  and  subsequent  filtration 
through  calcined  iron  ore,  has  also  been  tried,  but  with 
little  better  results.  Other  salts,  such  as  salts  of  zinc 
and  manganese,  and  carbolates  of  lime  and  magnesia, 
have  been  proposed  as  adjuvants  to  the  lime-process,  but 
they  all  fail  in  separating  the  ammonia  and  other  manur- 
ing material.  They  disinfect  the  sewage  for  the  time 
being,  but  do  not  prevent  subsequent  decomposition. 

(2.)  Myth's  process  consists  in  the  addition  of  a  salt 
of  magnesia  and  some  lime  superphosphate,  or  super- 
phosphate of  magnesia  and  lime  water,  with  the  view  of 
purifying  the  sewage  by  the  formation  of  the  triple 
phosphate  of  magnesia,  ammonia,  and  water.  Such  a 
precipitate,  however,  can  only  take  place  in  water  con- 
taining an  excess  of  ammonia ;  so  that  the  whole  process, 
while  being  more  costly  than  others,  was  found  to  be  as 
inefficient. 

(3.)  In  Holders  process,  a  mixture  of  iron  sulphate, 
lime,  coal-dust,  and  clay,  is  added  to  the  sewage,  but  it 

z 


338         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

fails  to  remove  the  nitrogenous  matters  in  solution,  and 
indeed  increases  their  amount  by  dissolving  some  of  the 
suspended  constituents. 

(4.)  Bird's  process,  which  was  tried  at  Cheltenham, 
but  abandoned,  consists  in  the  addition  of  crude  sulphate 
of  alumina,  and  subsequent  filtration  through  coke.  The 
sulphate  of  alumina  was  obtained  by  treating  pulverised 
clay  with  strong  sulphuric  acid.  In  this  and  Stotherd's 
process,  which  somewhat  resembles  it,  the  effluent  liquid 
was  not  found  to  be  sufficiently  purified  for  admission 
into  a  river  without  creating  a  nuisance. 

(5.)  The  "  A  B  C"  or  Sillars  process. — This  process, 
which  attracted  so  much  attention  some  few  years  ago, 
had  a  prolonged  trial  at  Leamington  on  an  extensive 
scale,  and  was  ultimately  pronounced  to  be  a  failure.  It 
consisted  in  adding  a  mixture  of  alum,  blood,  clay,  char- 
coal, a  salt  of  manganese,  and  other  ingredients,  to  the 
sewage  as  it  entered  the  works.  A  precipitate  was  thus 
obtained,  which  settled  to  the  bottom  of  the  tanks  in  the 
form  of  a  soft  black  mud.  This  was  afterwards  pumped 
up  into  receptacles,  from  which  it  ran  into  centrifugal 
drying  machines,  or  was  removed  into  drying  chambers. 
But  in  either  case  it  was  subsequently  spread  out  on  the 
ground  to  complete  the  drying  process,  and  the  mass  was 
from  time  to  time  sprinkled  with  sulphuric  acid  to  fix 
the  ammonia.  It  would  appear,  from  the  conclusions  of 
the  Eivers  Pollution  Commissioners,  that,  though  it  was 
superior  in  some  respects  to  the  processes  already  described, 
it  was  nevertheless  an  inefficient  purifier.  It  is  but  right 
to  state,  however,  that  the  process  has  recently  been 
much  improved,  and  is  now  carried  on  successfully  at 
Aylesbury  (Sanitary  Record,  1880). 

(6.)   Tlie  Phosphate  process,  as  proposed   by  Messrs. 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.          £39 

Forbes  and  Price,  consists  in  adding  to  the  sewage  a 
solution  of  the  native  phosphate  of  alumina,  dissolved  in 
sulphuric  or  hydrochloric  acid,  and  diluted  in  water. 
The  resulting  manure  has  been  estimated  by  Dr.  Voelcker 
at  £7  :  7s.  per  ton.  The  effluent  water  is  clarified  and 
disinfected,  but  not  by  any  means  freed  from  putrescible 
or  fertilising  matters,  and  the  originators  of  the  process 
have  themselves  pointed  out  that  it  is  only  intended  as  a 
preliminary  step  to  irrigation,  where  that  can  be  carried 
out.  Where  irrigation  is  impossible,  the  process  is  com- 
pleted by  adding  milk  of  lime,  to  precipitate  the  phos- 
phates in  solution.  The  process  generally  has  been 
favourably  reported  on. 

(7.)  In  HilUs  process  the  mixture  consists  of  lime, 
tar,  calcined  magnesium  chloride,  and  some  other  substance 
not  named.  The  lime  is  slaked,  and  the  tar  added  while 
it  is  hot.  The  whole  ingredients  are  subsequently  mixed 
with  water,  and  flow  through  a  large  tap  into  the  tank 
which  receives  the  sewage.  Here  precipitation  takes 
place,  and  the  sewage,  completely  deodorised,  passes  into 
a  second  tank,  where  the  deposit  settles.  The  effluent 
water  is  afterwards  filtered  through  a  charcoal  basket 
into  a  third  tank,  is  received  into  a  fourth,  and  over- 
flows from  this  into  a  small  brook.  The  working  ex- 
penses of  the  process  are  small,  but  the  manure  is  not 
valuable. 

(8.)  General  Scott's  process  differs  from  others  already 
described,  in  the  introduction  of  the  chemicals  into  the 
sewer  at  some  considerable  distance  from  the  outfall. 
The  precipitating  agents  consist  of  lime  and  clay  properly 
pulverised,  and  the  motion  of  the  sewage  in  its  onward 
flow  ensures  their  thorough  admixture  with  itself  before 
it  reaches  the  outfall.  The  resulting  sludge  which  is 
formed,  instead  of  causing  any  deposit  in  the  sewer,  as 


340          PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

some  anticipated,  acts  rather  as  a  scouring  agent,  and 
keeps  the  sewer  clean.  When  received  into  the  outfall 
tanks,  the  sewage  is  found  to  be  deodorised,  and  here  the 
suspended  matters  are  deposited.  These  are  subsequently 
removed  to  be  dried  and  burnt,  and  are  thus  converted 
into  a  useful  cement.  The  drying  process,  it  appears,  is 
not  attended  with  any  nuisance. 

The  British  Association  Sewage  Committee  have 
reported  favourably  on  the  whole  process,  as  solving  one 
of  the  difficulties  of  the  sewage  question,  namely,  the 
separation  and  deodorisation  of  the  offensive  ingredients 
in  an  efficient  manner,  at  a  comparatively  small  cost,  and 
of  easy  application  on  a  large  scale.  The  effluent  water, 
according  to  the  Committee's  analysis,  contains  rather 
more  than  two-thirds  of  the  chlorine  and  of  the  dissolved 
nitrogen  of  the  sewage.  It  is  therefore  too  valuable  to 
be  wasted,  and  too  impure  to  be  discharged  into  a  river, 
and  can  only  be  properly  dealt  with  by  irrigation. 

General  Scott's  process  has  been  carried  on  at  Ealing, 
West  Ham,  and  Birmingham. 

(9.)  WTiitthread's  process,  which  has  also  been  favour- 
ably reported  on  by  the  British  Association  Committee, 
consists  in  adding  to  the  sewage  a  mixture  containing 
two  equivalents  of  dicalcic  phosphate,  one  of  monocalcic 
phosphate,  and  a  little  milk  of  lime.  The  resulting  pre- 
cipitation was  found  to  be  very  rapid,  and  the  supernatant 
fluid  clear  and  inoffensive.  Suspended  matters  were 
completely  removed,  and  the  organic  nitrogen  nearly  so. 
It  was  considered  by  the  Committee  that  the  manure 
would  be  valuable,  as  it  contained  a  large  amount  of 
lime  phosphate  and  3  per  cent  of  ammonia.  As  the 
effluent  fluid  contained  phosphoric  acid  and  ammonia  it 
would  be  suitable  for  irrigation. 

(10.)  Dr.  Andersons  process,  first  tried  at  Nuneaton, 


PURIFICATION  AND  UTILISATION  OF  SEWAGE,          341 

has  been  carried  on  much  more  successfully  at  Coventry. 
It  consists  in  adding  an  impure  sulphate  of  alumina, 
made  by  dissolving  aluminous  shale  in  sulphuric  acid,  to 
the  sewer  water,  which  is  kept  constantly  stirred,  and 
which  afterwards  flows  into  a  series  of  settling  tanks. 
The  whole  of  the  machinery  is  admirably  planned,  and 
the  effluent,  especially  after  it  has  passed  through  an 
adjoining  filtering  area,  is  very  clear  and  fit  to  be  dis- 
charged into  any  river.  The  resulting  manure  does  not 
command  a  ready  sale,  and  the  works  were  carried  on  at 
considerable  loss.  Some  few  years  ago,  the  works  were 
taken  over  by  the  Corporation,  who  pay  the  Company  a 
fixed  sum  annually. 

2.  Filtration  processes. 

(1.)  Simple  Filtration. — In  this  process  the  sewage  is 
merely  strained  or  screened,  so  that,  although  almost  all 
the  suspended  matters  are  removed,  the  effluent  fluid  is 
not  by  any  means  purified.  The  mud  which  collects  at 
the  bottom  of  the  filtering  tanks  is  generally  mixed  with 
the  town  ashes  and  sold  as  manure. 

(2.)  Carbon,  as  in  Weare's  process,  has  been  tried  to 
purify  sewage  by  filtration,  but  it  does  not  appear  to  have 
been  very  successful.  Very  possibly,  if  it  could  be 
obtained  at  a  cheap  rate  and  the  filtration  were  made 
intermittent,  it  would  be  found  to  answer  with  small 
quantities  of  sewage  where  land  cannot  be  procured.  A 
cheap  kind  of  carbon  is  now  manufactured  for  this  pur- 
pose, called  Sanitary  Carbon. 

(3.)  Upward  Filtration. — This  process  was  at  one 
time  carried  on  at  Baling,  but  the  results  were  not  satis- 
factory. 

(4.)   Intermittent  Dovmward  Filtration. — Amongst  the 


342         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

numerous  important  experiments  conducted  under  the 
direction  of  the  Eivers  Pollution  Commissioners,  there 
were  none  attended  with  better  results  than  the  filtration 
of  sewage  through  a  considerable  depth  of  soil.  The  ex- 
periments were  made  on  sand,  on  a  mixture  of  sand  and 
chalk,  and  on  different  soils.  The  results  varied  a  good 
deal  according  to  the  quality  of  the  soil,  but  in  all  of  them 
it  was  found  that  the  suspended  matters  were  entirely 
removed,  and  that  the  organic  carbon  and  nitrogen  were 
greatly  reduced.  According  to  the  report  of  the  Com- 
//  missioners,  "  These  experiments  also  show  that  the  process 
of  purification  is  essentially  one  of  oxidation,  the  organic 
matter  being  to  a  large  extent  converted  into  carbonic 
acid,  water,  and  nitric  acid ;  hence  the  necessity  for  the 
continual  aeration  of  the  filtering  medium,  which  is 
secured  by  intermittent  downward  filtration,  but  entirely 
•  prevented  by  upward  filtration." 

The  process  was  for  some  time  carried  on  at  Merthyr 
Tydfil,  according  to  the  plans  of  Mr.  Bailey  Denton,  C.E. ; 
and  the  following  abstract  from  the  report  of  the  British 
Association  Sewage  Committee  will  afford  a  sufficient 
description  of  the  various  details  and  the  results  : — The 
filtering  area  or  farm  was  about  20  acres  in  extent,  and 
consists  of  a  very  porous  gravelly  subsoil,  covered  with 
vegetable  mould.  It  was  pipe -drained  to  the  depth  of 
about  7  feet,  the  drains  conveying  to  the  lowest  corner, 
where  the  effluent  water  was  discharged  into  a  small 
stream  leading  into  the  river  Taff.  The  area  was  laid  out 
in  square  beds,  intersected  by  paths,  along  which  were 
constructed  the  main  carriers,  which  received  the  sewage 
from  the  outfall  sewer,  where  it  was  screened  through  a 
bed  of  clay,  and  distributed  it  over  the  beds.  In  order 
to  supply  the  sewage  on  the  intermittent  system,  the  area 
was  divided  into  four  equal  portions,  each  portion  receiv- 
ing the  whole  of  the  sewage  for  six  hours  in  succession, 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.         343 

and  thus  leaving  an  interval  of  eighteen  hours  for  rest 
and  aeration  of  the  soil.  The  surface  of  the  land  was 
cultivated  to  a  depth  of  about  18  inches,  and  was  laid 
up  in  ridges  to  allow  of  the  sewage  running  down  the 
furrows.  The  ridges  were  planted  with  cabbages  and 
other  vegetables. 

The  results  of  the  process,  as  stated  by  the  Committee, 
were  highly  satisfactory.  All  the  suspended  matters  were 
removed,  and  the  ammonia  and  nitrogenous  organic  matters 
were  almost  completely  oxidised,  so  that  they  escaped  in 
the  effluent  water  as  nitrites  and  nitrates.  They  added, 
however,  that  though  the  sewage  was  thus  efficiently 
purified,  the  process  could  not  be  regarded  as  one  of 
utilisation. 

Since  that  report  was  published  in  1872,  additional 
land  has  been  obtained  to  the  extent  of  230  acres,  and 
the  intermittent  downward  filtration  process  has  been 
supplanted  by  simple  irrigation,  in  order  that  better  re- 
turns might  be  obtained. 

The  requisite  extent  of  filtering  area,  as  estimated  by 
the  Eivers  Pollution  Commissioners,  is  1  acre  drained  to  a 
depth  of  6  feet  for  every  3300  of  the  population  ;  but  this 
ratio  must  vary  according  to  the  nature  of  the  soil.  The 
soil  should  be  porous  and  the  surface  have  an  easy  slope. 

At  Kendal,  with  a  population  of  13,700,  this  method 
has  been  successfully  carried  out  on  an  area  of  10  acres. 

3.  Irrigation. — It  is  now  generally  conceded  that  this 
is  the  only  process  which  fully  meets  all  the  requirements 
attaching  to  the  disposal  of  sewage ;  in  other  words,  it  is 
the  only  one  which,  while  it  purifies  the  sewage  efficiently, 
realises  the  highest  profits,  and  may  be  carried  on  without 
creating  any  nuisance  or  detriment  to  the  health  of  the 
neighbouring  inhabitants.  But  in  order  that  the  process 
may  be  carried  out  satisfactorily,  it  is  necessary — 


344         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

(1.)  That  the  acreage  be  sufficient.  This  will  depend 
in  great  measure  on  the  looseness  or  porosity  of  the  soil ; 
— hence  to  lay  down  as  a  rule  that  1  acre  should  be 
allowed  for  every  100  inhabitants,  which  is  the  estimate 
usually  given  by  engineers,  is  manifestly  illogical. 

(2.)  The  land  to  be  irrigated  must  be  drained,  and 
stiff  clayey  soils  broken  up  and  mixed  with  ashes,  sand, 
or  lime. 

(3.)  The  surface  must  be  irrigated  on  the  intermittent 
system,  to  ensure  sufficient  aeration  of  the  soil. 

(4.)  The  ground  should  be  laid  out  in  broad  ridges 
and  furrows,  the  sewage  being  conveyed  along  the  tops  of 
the  ridges  in  open  carriers,  and  made  to  flow  gently  down 
the  slopes  by  inserting  temporary  sluices  in  regular  suc- 
cession and  at  regular  intervals.  At  Breton's  Farm,  near 
Eomford,  the  breadth  of  the  ridge  is  30  feet,  giving  a 
slope  of  15  feet  on  either  side  of  the  carriers.  At  Lord 
Warwick's  Farm  near  Leamington,  Mr.  Tough,  the  man- 
ager, informs  me  that  the  ridge  varies  from  50  feet  wide, 
according  to  circumstances. 

(5.)  There  must  be  a  rotation  of  crops  such  as  Italian 
rye -grass,  peas,  maize,  different  roots,  cabbages,  etc.,  and 
where  land  is  plentiful,  it  always  pays  to  let  portions  of 
it  rest  for  a  time  for  the  growth  of  cereal  crops. 

(6.)  The  sewage  should  be  delivered  in  a  fresh  state, 
and  freed  from  the  coarser  portion  of  its  suspended  matters. 
This  may  be  effected  either  by  precipitation,  filtration,  or 
screening.  At  Lord  Warwick's  farm,  the  borough  of  War- 
wick farm,  and  the  Rugby  farm,  the  sewage  is  simply 
screened  and  delivered  fresh  on  to  the  land. 

Such,  briefly,  are  the  principal  details  connected  with 
sewage-farming,  and  it  is  the  neglect  of  one  or  more  of 
them  which  has  brought  so  much  opprobrium  on  the 
system.  If  the  irrigated  soil  becomes  water -logged  and 
swampy,  the  fault  lies  with  the  engineering  and  manage- 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.          345 


ment,  not  with  the  system.  Or,  again,  if  the  farm  becomes 
a  nuisance,  it  is  because  the  sewage  is  not  properly  dis- 
tributed, or  the  carriers  kept  free  from  deposit. 

The  comparative  results  of  the  different  processes  of 
purification  are  stated  by  the  Kivers  Pollution  Commis- 
sioners as  follows : — 

Average  Results. 


Percentage  of  Dissolved 
Organic  Pollution 
removed. 

Percentage  of 
suspended  Or- 
ganic Impurity 
removed. 

Organic 
Carbon. 

Organic 
Nitrogen. 

Chemical  processes 
Upward  filtration  .     . 
Downward  nitration  . 
Irrigation     .... 

28-4 
26-3 
72-8 
68-6 

36-6 
437 
87-6 
817 

89-8 
100- 
100- 
977 

This  table  shows  that,  in  order  to  obtain  the  best 
purifying  results,  irrigation  should  always  be  combined 
with  intermittent  downward  filtration.  With  regard  to 
'towns  where  a  sufficiency  of  land  cannot  be  procured  for 
irrigating  purposes,  the  process  of  downward  filtration,  as 
carried  on  at  Kendal,  should  be  adopted,  and,  in  either 
case,  the  ashes  and  other  town-refuse  can  be  largely  used 
in  clarifying  or  disinfecting  the  sewage  before  it  is  de- 
livered on  the  filtering  ground.  Trade  or  manufacturing 
pollution  must  be  treated  according  to  the  nature  of  the 
pollution. 

Where  no  sufficient  amount  of  land  can  be  procured, 
as  in  the  case  of  numbers  of  large  inland  towns,  recourse 
must  be  had  to  purification  by  some  chemical  process,  but 
in  many  instances  the  difficulties  are  so  enormous,  that 
the  pollution  of  neighbouring  streams  cannot  be  prevented 
unless  at  a  cost  which  would  irretrievably  ruin  commercial 
enterprise.  Even  were  all  trade-refuse  and  sewage  excluded 


346         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

from  streams,  the  mere  surf  ace -wash  ings  of  large  towns 
are  sufficient  of  themselves  to  convert  many  of  them  into 
foul  rivers,  which  no  legal  enforcement  of  riparian  rights 
nor  any  number  of  Eivers  Pollution  Bills  can  ever  render 
pure.  Indeed,  at  Birmingham,  Leeds,  and  other  inland 
towns,  the  effluent  is  much  purer  than  the  filthy  streams 
into  which  it  discharges.  Sanitary  reformers  are  too  apt 
to  forget  that,  though  streams  and  rivers  may,  and  often 
do,  prove  valuable  sources  of  water-supply,  they  are  never- 
theless the  natural  drainage  outfalls  of  the  country,  and 
while  many  of  them  may  be  preserved  from  injurious 
pollution,  there  are  numbers  of  others  doomed  to  such  an 
amount  of  pollution  that,  no  matter  what  preventive  means 
may  be  adopted,  fish  can  scarcely  live  in  them,  and  their 
turbid  waters,  however  carefully  purified,  can  never  be 
safe  to  drink.  It  is  evident,  therefore,  that  with  regard 
to  river  pollution,  the  special  circumstances  of  every  large 
town  involved  in  sewage-difficulties  must  be  taken  into 
account,  and  that  no  hard-and-fast  rule  can  be  enforced 
by  Act  of  Parliament  which  shall  be  applicable  to  all 
alike. 

The  following  were  the  conclusions  adopted  by  the 
Executive  Committee  of  the  Conference  on  the  health  and 
sewage  of  towns,  held  under  the  auspices  of  the  Society  of 
Arts  in  May  1876,  and  they  are  appended  here  as  afford- 
ing a  full  and  fair  exposition  of  the  various  aspects  of  this 
difficult  problem  of  sewage  treatment  and  utilisation : — 

"  1.  In  certain  localities,  where  land  at  a  reasonable  price  can 
be  procured,  with  favourable  natural  gradients,  with  soil  of  a  suit- 
able quality,  and  in  sufficient  quantity,  a  sewage  farm,  if  suitably 
conducted,  is  apparently  the  best  method  of  disposing  of  water- 
carried  sewage.  It  is  essential,  however,  to  bear  in  mind  that  a 
profit  should  not  be  looked  for  by  the  locality  establishing  the 
sewage  farm,  and  only  a  moderate  one  by  the  farmer. 

"  2.  With  regard  to  the  various  processes  based  upon  subsidence, 
precipitation,  or  nitration,  it  is  evident  that  by  some  of  them  a  suf- 


PURIFICATION  AND  UTILISATION  OF  SEWAGE.         347 

ficiently  purified  effluent  can  be  produced  for  discharge,  without 
injurious  result,  into  watercourses  and  rivers  of  sufficient  magnitude 
for  its  considerable  dilution  ;  and  that  for  many  towns,  where  land 
is  not  readily  obtained  at  a  moderate  price,  those  particular  processes 
afford  the  most  suitable  means  of  disposing  of  water-carried  sewage. 
It  appears,  further,  that  the  sludge,  in  a  manurial  point  of  view,  is 
of  low  and  uncertain  commercial  value  ;  that  the  cost  of  its  conver- 
sion into  a  valuable  manure  will  preclude  the  attainment  of  any 
adequate  return  in  the  outlay  and  working  expenses  connected 
therewith,  and  that  means  must  therefore  be  used  for  getting  rid 
of  it  without  reference  to  possible  profit. 

"  3.  In  towns  where  a  water-carried  system  is  employed,  a  rapid 
flow,  thorough  ventilation,  a  proper  connection  of  the  house  drains 
and  pipes  with  the  sewers,  and  their  arrangement  and  maintenance 
in  an  efficient  condition,  are  absolutely  essential  as  regards  health  ; 
hitherto  sufficient  precautions  have  rarely  been  taken  for  efficiently 
ensuring  all  the  foregoing  conditions. 

"  4.  "With  regard  to  the  various  dry  systems,  where  collection 
at  short  intervals  is  properly  carried  out,  the  result  appears  to  be 
satisfactory,  but  no  really  profitable  application  of  any  one  of  them 
appears  as  yet  to  have  been  accomplished. 

"5.  The  old  midden  or  privy  system  in  populous  districts 
should  be  discontinued,  and  prohibited  by  law. 

"  6.  Sufficient  information  was  not  brought  forward  at  the  Con- 
ference to  enable  the  Committee  to  express  an  opinion  in  regard  to 
any  of  the  foreign  systems. 

"  7.  It  was  conclusively  shown  that  no  one  system  for  disposing 
of  sewage  could  be  adopted  for  universal  use  ;  that  different  locali- 
ties require  different  methods  to  suit  their  special  peculiarities  ;  and 
also  that,  as  a  rule,  no  profit  can  be  derived  at  present  from  sewage 
utilisation. 

**  8.  For  health's  sake,  without  consideration  of  commercial 
profit,  sewage  and  excreta  must  be  got  rid  of  at  any  cost." 

To  those  who  are  interested  in  the  monetary  details 
of  the  question,  the  following  table  from  the  report  on 
sewage-disposal  by  the  Committee  appointed  by  the  Local 
Government  Board  in  1876,  gives  the  cost  in  different 
towns  by  different  processes  in  proportion  to  the  annual 
rateable  value,  etc.,  for  the  year  1875  :— 


348         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 


BY  IRRIGATION. 

NAME  OF  TOWN. 

Population 
(about.) 

Number  of 
Houses. 

No.  of 
Water- 

Annual 
Kateable 

Per  £  of 
Eateable  Value. 

Sewage. 

Scavenging. 

1.  Banbury     .     . 

12,000 

3,485 

2,485 

£34,104 

Id. 

2.  Bedford  .     .     . 

18,000 

3,500 

3,000 

65,000 

Id. 

— 

3.  Blackburn  .     . 

90,000 

16,700 

730 

235,127 

8d. 

8JcL 

4.  Cheltenham     . 

45,000 

8,725 

8,500 

217,849 

id. 

id. 

5.  Chorley  .     .     . 

20,000 

4,000 

200 

54,407 

4|d. 

2jd. 

6.  Doncaster  . 

20,000 

4,300 

— 

68,721 

Sid. 

— 

7.  Harrogate  . 

12,000 

1,500 

1,620 

50,000 

5|d. 



8.  Leamington     . 

24,700 

4,500 

8,370 

113,400 

5M. 

Id. 

9.  Merthyr-Tydfil 

55,000 

10,778 

8,000 

135,000 

7£d. 

— 

10.  Rugby    .     .     . 

8,400 

1,700 

1,400 

45,000 

ijd. 

— 

11.  Tunbridge  Wells 

23,000 

5,750 

5,635 

142,914 

lOd. 

— 

12.  Warwick     .     . 

11,000 

2,400 

2,000 

43,339 

6|d. 



13.  Wolverhampton 
14.  West  Derby     . 

71,000 
31,400 

14,000 

750 
3,220 

210,000 
163,000 

2d. 
4d. 

lid. 
lid. 

BY  LAND  FILTRATION. 

15.  Kendal  .     .     . 

13,700 

2,727 

450 

£44,600 

4d. 

— 

BY  PRECIPITATION. 

16.  Birmingham    . 

350,000 

83,420 

8,000 

£ 
1,229,844 

4£d. 

5fd. 

17.  Bolton-le-Moors 

93,100 

18,249 

758 

311,563 

2d. 

l£d. 

18.  Leeds     .     .     . 

285,000 

57,000 

8,000 

945,141 

4fd. 

4M. 

19.  Bradford     .     . 

173,723 

34,000 

4,050 

745,671 

3£d. 

2fcL 

BY  THE  PAIL  SYSTEM. 

i 
20.  Halifax  .     .     . 

68,000 

11,218 

2,600 

£262,581 

_ 

4d. 

21.  Rochdale     .     . 

67,000 

.  14,388 

350 

222,000 

8|d. 

PURIFICATION  AND  UTILISATION  OF  SEWAGE.         349 


SECTION  III. — TREATMENT  OF  VILLAGE  SLOPS. 

Some  slight  reference  has  already  been  made  to  this 
part  of  the  subject  in  the  previous  chapter,  but  the  follow- 
ing remarks  are  submitted  in  the  hope  that  they  may 
prove  of  further  service  in  assisting  to  clear  up  many  of 
the  difficulties  in  which  this  important  question  is  involved. 
They  are  quoted  from  the  pamphlet  on  Sanitary  Defects 
in  Kural  Districts,  already  alluded  to,  and  are  an  attempt 
to  explain  the  principles  on  which  my  own  recommenda- 
tions have  been  based,  when  local  circumstances  are  taken 
into  account : — 

"If  the  village  drains  into  a  large  stream  which  is 
not  used  for  drinking  purposes  below  the  village,  and 
provided  there  is  no  nuisance  at  the  outfall,  I  have  not 
considered  it  necessary  to  recommend  any  interference. 
If,  again,  the  village  drains  into  an_open  ditch  without 
creating  nuisance,  it  will  generally  be  found  that  a  large 
catch-pit  will  suffice,  provided  all  excremental  filth  and 
slaughter-house  refuse  are  kept  out  of  the  drains.  But 
in  all  cases  in  which  there  is  nuisance  at  the  outfall,  or 
risk  of  water  pollution  used  for  drinking  purposes,  I 
recommend  that  the  sewage,  if  it  be  at  all  possible, 
should  be  purified  by  irrigation  or  sub-irrigation,  and 
failing  these,  that  it  should  be  filtered  through  a  filter  of 
sufficient  size  and  on  the  intermittent  downward  filtration 
system.  In  some  localities  where  the  soil  is  porous,  and 
the  quantity  of  sewage  comparatively  small,  a  dumb-well 
in  a  field  will  satisfactorily  solve  the  difficulty,  or  the 
outfall  drain  may  be  carried  alongside  a  field  ditch  of 
lower  depth,  and  the  soil  between  will  act  as  a  ready 
filter.  Indeed,  in  purely  agricultural  districts,  the  various 
expedients  which  might  be  easily  adopted  for  the  purifi- 
cation and  utilisation  of  village  slops  are  so  accessible,  so 


350         PURIFICATION  AND  UTILISATION  OF  SEWAGE. 

to  speak,  that  in  the  great  majority  of  instances  there  not 
only  need  be  no  difficulty  in  treating  them  efficiently,  but 
if  properly  utilised  they  will  pay  a  fair  return  to  any 
farmer  who  is  public-spirited  enough  to  take  them.  As 
a  rule,  however,  the  method  of  applying  them  to  the  soil 
is  anything  but  satisfactory.  Very  often  the  quantity  is 
so  small  that  unless  a  tank  is  provided,  which  can  be 
periodically  emptied,  the  sewage  trickles  along  the  surface- 
gutter  in  the  field,  and  finally  disappears  without  con- 
tributing any  of  its  fertilising  properties,  except  it  be  to 
the  sides  of  the  gutter,  on  which  some  rank  grass  is  found 
growing.  But  this  insufficiency  of  volume,  which  con- 
stitutes the  great  objection  which  farmers  have  to  village 
sewage,  can  easily  be  obviated  by  constructing  one  of 
Denton  and  Field's  automatic  sewage -meter  tanks,  in 
which  the  sewage  can  be  collected  for  a  period  of  twelve 
or  twenty-four  hours,  according  to  the  size  of  the  tank, 
and  by  means  of  a  self-acting  syphon  can  be  readily 
discharged  when  the  tank  becomes  full.  If  land  has  to 
be  purchased,  half  an  acre  to  three  quarters  of  an  acre  of 
ground  properly  drained  and  laid  out  would  be  quite 
sufficient  to  purify  the  slops  and  refuse-water  of  a  village 
containing  800  to  1000  inhabitants,  provided  the  sewage 
is  applied  on  this  intermittent  system,  and  the  subsoil  is 
porous.  Of  course,  if  simple  irrigation  should  be  carried 
out,  some  three  or  four  acres  would  be  required,  but  in 
any  case  I  should  recommend  the  automatic  sewage-meter 
tank  to  secure  rapidity  and  intermittency  of  flow. 

"  Sometimes  the  question  is  raised  as  to  whether  vil- 
lage slops  possess  any  agricultural  value  at  all.  For  my 
own  part,  I  am  inclined  to  believe  that  they  possess 
fertilising  properties  quite  equal  to  those  of  ordinary  town 
sewage ;  and,  as  an  instance  in  point,  I  may  mention  that 
one  of  the  rural  sanitary  authorities  in  my  district  receives 
a  rental  of  about  £6  an  acre  for  a  small  field  laid  out  in 
grass,  which  was  purchased  for  the  purification  and  utilisa- 


PUBLICATION  AND  UTILISATION  OF  SEWAGE.         351 

Lion  of  the  slops  of  an  average-sized  village.  Indeed,  any 
one  who  takes  the  trouble  to  use  the  household  slops  in 
the  garden  will  soon  find  for  himself  that  the  increase  in 
garden  produce  will  more  than  compensate  for  the  extra 
trouble.  And  here  I  may  remark,  that  part  of  the  objec- 
tions which  farmers  generally  have  to  village  sewage  may 
be  fairly  attributed  to  their  not  unnatural  opposition  to 
any  village  improvements  which  are  likely  to  increase  the 
rates,  and  from  which  they  do  not  receive  any  direct 
benefit.  In  places  where  both  intermittent  downward 
filtration  and  simple  irrigation  are  objected  to  on  account 
of  their  unsightliness,  or  the  possibility  of  their  giving 
rise  to  nuisance,  the  slops  of  a  small  village,  if  separated 
from  the  surface  water,  could  be  satisfactorily  disposed  of 
by  sub-irrigation.  In  short,  the  difficulties  to  be  en- 
countered with  regard  to  village  drainage  and  purification 
of  slops,  as  I  have  already  said,  are  not  so  much  engineer- 
ing difficulties  ;  the  great  difficulty  in  many  rural  districts 
is  to  get  anything  done  at  all  in  this  direction. 

"  In  sub-irrigation,  the  drains  consist  of  common 
agricultural  pipes  laid  at  a  depth  of  about  1 2  inches  below 
the  surface  upon  a  bed  of  larger  pipes  divided  longitudi- 
nally in  half,  so  that  the  slops  soak  through  between  the 
open  joints  into  the  subsoil,  part  of  them  filtering  into 
the  ground,  and  part  of  them  being  absorbed  by  the 
vegetation  on  the  surface.  The  system  may  be  used  in 
gardens,  and  is  specially  applicable  to  land  which  is 
reserved  for  pasture  land.  Mr.  Field  recommends  that 
the  drains  should  be  taken  up  and  relaid  at  least  once  a 
year,  and  it  is  always  advisable  to  have  the  subsoil  deep- 
drained.  Where  the  system  is  adopted,  as  at  Shenfield 
near  Brentwood,  for  separate  houses  or  groups  of  houses, 
care  must  be  taken  to  avoid  pollution  of  the  wells  by 
laying  a  longer  or  shorter  portion  of  water-tight  drain, 
according  to  circumstances,  between  the  flush-tank  and 
the  sub -irrigation  drains." 


352  EFFECTS  OF  IMPROVED  DRAINAGE 


CHAPTER    XIII. 

xj 

THE  EFFECTS  OF  IMPROVED  DRAINAGE  AND  SEWERAGE  ON 
PUBLIC  HEALTH. 

THIS  subject  may  be  conveniently  considered  as  follows  : — 

1.  The   effects   of  dampness   of  soil   on   the   public 
health. 

2.  The  sanitary  aspects  of  the  water-carriage  system 
of  excretal  removal. 

3.  The  sanitary  aspects  of  sewage-irrigation. 

SECTION  I. — THE  EFFECTS  OF  DAMPNESS  OF  SOIL  ON 
PUBLIC  HEALTH. 

Amongst  the  numerous  valuable  reports  which  Dr. 
Buchanan,  in  his  capacity  of  Health-Inspector,  has  sub- 
mitted to  the  Privy  Council,  there  is  perhaps  none  which 
excited  greater  interest  at  the  time  than  his  report  "  On 
the  Distribution  of  Phthisis  as  affected  by  Dampness  of 
Soil."  In  a  previous  investigation  regarding  the  effects 
of  improvements  in  drainage  and  water-supply,  Dr. 
Buchanan  had  ascertained  that  in  certain  towns  which 
had  been  improved  in  this  respect,  the  mortality  from 
phthisis  had  greatly  diminished;  and  not  only  so,  but 
the  rate  of  diminution  was  found  to  correspond  with  the 
extent  of  the  drying  of  the  subsoil.  This  result,  which 
was  so  far  unexpected,  led  to  the  important  inquiry  above 


AXD  SEWEKAGE  ON  PUBLIC  HEALTH.  353 

mentioned,  and  the  principal  facts  connected  with  both 
may  be  briefly  summarised  as  follows : — 

In  the  first  inquiry,  it  was  found  that  wherever  the 
drying  of  the  subsoil  had  been  effected,  either  by  the  con- 
struction of  drain-sewers,  or  by  special  drains  and  deep 
storm-culverts,  when  the  pipe-system  was  carried  out,  the 
mortality  from  phthisis  had  decreased  from  about  50  per 
cent  downwards.  In  Salisbury,  for  example,  the  death- 
rates  from  phthisis  had  fallen  49  per  cent;  in  Ely,  47  ; 
in  Rugby,  43  ;  in  Banbury,  41 ;  and  in  13  other  towns 
the  rate  of  diminution,  though  not  so  marked,  was  never- 
theless noteworthy.  On  the  other  hand,  it  also  became 
apparent  that  in  certain  towns,  such  as  Alnwick,  Stafford, 
Morpeth,  and  Ashley,  where  no  drying  of  the  subsoil  had 
been  effected,  there  was  no  reduction  in  the  phthisis  death- 
rate,  even  although  the  greatest  possible  progress  had  been 
achieved  in  the  removal  of  filth.  This  was  owing  to  the 
fact  that  in  these  towns  impervious  pipe-sewers  had  been 
laid  down,  without  making  any  provision  for  deep  subsoil- 
draining,  the  storm-water  being  carried  off  in  superficial 
culverts.  In  some  towns,  again,  such  as  Penzance,  where 
the  subsoil  was  already  dry,  the  phthisis  death-rate  re- 
mained stationary  ;  and  in  others,  where  plans  of  drainage 
had  been  carried  out,  the  sanitary  advantages,  as  regards 
phthisis,  were  nullified,  because,  as  in  the  case  of  Carlisle, 
they  were  so  low-lying  that  the  subsoil  was  at  all  times  more 
or  less  waterlogged.  So  far,  therefore,  the  relation  between 
dampness  of  soil  and  phthisis,  as  one  of  cause  and  effect, 
became  highly  probable,  and  Dr.  Buchanan's  second  inquiry 
converted  the  probability  into  a  scientific  certainty. 

In  this  special  inquiry  (see  Tenth  Eeport  of  the 
Medical  Officer  of  the  Privy  Council)  the  various  registration 
districts  in  the  three  south-eastern  counties  of  England, 
beyond  the  limits  of  the  metropolis,  were  brought  under 
detailed  examination,  and.  considered  in  two  ways.  Firstly, 

2  A 


354  EFFECTS  OF  IMPROVED  DEAINAGE 

the  true  phthisis-rate  of  the  population  was  ascertained, 
and  due  allowance  made  for  the  causes  of  the  disease 
which  were  likely  to  influence  the  rate  besides  the  nature 
of  the  soil ;  and  secondly,  the  numbers  of  the  population, 
in  each  district,  that  were  found  "living  upon  various 
kinds  of  soil,  and  under  various  topographical  conditions," 
were  also  noted.  The  results  of  these  two  separate  lines 
of  investigation  were  then  brought  together,  and  statistic- 
ally compared. 

Without  entering  into  any  of  the  geological  details, 
which  are  fully  given  in  Dr.  Buchanan's  report,  it  may 
be  said,  generally,  that  the  dampness  or  dry  ness  of  a  soil 
depends  partly  on  whether,  if  pervious,  it  is  retentive  of 
water,  or,  if  impervious,  the  water  can  readily  drain  away. 
Again,  it  is  obvious  that  pervious  soils  may  present  very 
different  degrees  of  dryness  or  wetness,  according  to  the 
elevation  of  the  ground,  and  the  dip  of  underlying  imper- 
vious beds.  Thus,  a  stratum  of  gravel  or  chalk,  covering 
a  sloping  bed  of  impervious  clay,  is  necessarily  a  dry  soil, 
because  the  rainfall  readily  sinks  to  and  flows  along  the 
surface  of  the  impervious  slope,  whereas  the  same  stratum 
in  a  valley  may  be  actually  waterlogged,  although  the 
depth  of  the  stratum  may  be  the  same  throughout. 
Bearing  in  mind,  then,  the  topographical  relations  as  well 
as  the  physical  qualities  of  different  soils,  the  following 
general  conclusions,  given  by  Dr.  Buchanan  as  the  result 
of  his  inquiry,  will  be  at  once  understood  :— 

"(1.)  Within  the  counties  of  Surrey,  Kent,  and 
Sussex,  there  is,  broadly  speaking,  less  phthisis  among 
populations  living  on  pervious  soils  than  among  popula- 
tions living  on  impervious  soils. 

"  (2.)  Within  the  -same  counties  there  is  less  phthisis 
among  populations  living  on  high -lying  pervious  soils 
than  among  populations  living  on  low-lying  pervious  soils. 

"  (3.)  Within  the  same  counties  there  is  less  phthisis 


AND  SEWERAGE  ON  PUBLIC  HEALTH.  355 

among  populations  living  on  sloping  impervious  soils  than 
among  populations  living  on  flat  impervious  soils. 

"  (4.)  The  connection  between  soil  and  phthisis  has 
been  established  in  this  inquiry — 

"  (a)  By  the  existence  of  general  agreement  in  phthisis- 
mortality  between  districts  that  have  common  geological 
and  topographical  features,  of  a  nature  to  affect  the  water- 
holding  quality  of  the  soil ; 

"  (b)  By  the  existence  of  general  disagreement  between 
districts  that  are  differently  circumstanced  in  regard  of 
such  features ;  and 

"  (c)  by  the  discovery  of  pretty  regular  concomitancy 
in  the  fluctuation  of  the  two  conditions,  from  much 
phthisis  with  much  wetness  of  soil  to  little  phthisis  with 
little  wetness  of  soil. 

"(5.)  The  whole  of  the  foregoing  conclusions  com- 
bine into  one — which  may  now  be  affirmed  generally,  and 
not  only  of  particular  districts — that  wetness  of  soil  is  a 
cause  of  phthisis  to  the  population  living  upon  it." 

It  is  interesting  to  note  that  this  new  discovery  in 
the  etiology  of  disease,  which  in  this  country  has  been 
associated  with  Dr.  Buchanan's  name,  had  already  been 
brought  to  the  notice  of  the  profession  in  America  by 
Dr.  Bowditch,  of  Boston,  U.S.  It  would  appear,  how- 
ever, that  Dr.  Bowditch's  researches  were  not  known  in 
England  until  after  Dr.  Buchanan's  inquiry  had  been 
finished :  and  although  the  priority  rests  with  him,  the 
credit  of  independently  establishing  causation  of  phthisis 
by  dampness  of  soil  as  a  general  law  in  this  country 
remains  with  Dr.  Buchanan.  But  it  would  be  unfair  not 
to  quote  Dr.  Bowditch's  own  remarks.  In  a  very  able 
and  lucid  address  delivered  to  the  Massachusetts  Medical 
Society  in  1862,  he  submitted  the  two  following  proposi- 
tions as  containing  the  essential  results  of  very  extended 
inquiry : — 


356  EFFECTS  OF  IMPROVED  DRAINAGE 

"  First. — A  residence  in  or  near  a  damp  soil,  whether 
that  dampness  be  inherent  in  the  soil  itself,  or  caused  by 
percolation  from  adjacent  ponds,  rivers,  meadows,  marshes, 
or  springy  soils,  is  one  of  the  principal  causes  of  consump- 
tion in  Massachusetts,  probably  in  New  England,  and 
possibly  in  other  portions  of  the  globe. 

"  Second. — Consumption  can  be  checked  in  its  career, 
and  possibly,  nay  probably,  prevented  in  some  instances, 
by  attention  to  this  law." 

But,  in  addition  to  phthisis,  there  are  other  diseases 
whose  prevalency  is  largely  affected  by  dampness  of  soil. 
Thus,  rheumatism,  heart-disease,  catarrhal  complaints,  and 
ague,  are  especially  common  in  damp  districts ;  and  no 
greater  proof  can  be  given  of  the  sanitary  advantages 
arising  from  drainage  on  an  extensive  scale  than  the  total 
disappearance  of  the  last-named  disease  in  various  parts 
of  the  country  where  it  was  at  one  time  so  common. 
Moreover,  it  is  evident  that  in  towns  situated  on  damp 
pervious  soils,  there  is  the  constant  danger  of  filth-accu- 
mulations finding  their  way  by  soakage  into  surface-wells, 
or,  as  has  previously  been  shown,  the  soil  may  eventually 
become  excrement-sodden,  so  that  the  air,  as  well  as  the 
well-water,  becomes  polluted.  It  is  in  this  sense  that  the 
views  of  Pettenkofer  with  regard  to  the  spread  of  cholera 
and  enteric  fever  become  so  important,  for  he  insists  on 
humidity  of  soil  as  a  necessary  factor  in  the  etiology  of 
any  localised  outbreak  of  either  disease. 

An  undrained  or  damp  state  of  soil,  especially  in 
populous  places,  is  thus  fully  proved  to  be  highly  inimical 
to  public  health,  and,  according  to  Mr.  Simon,  it  answers 
to  the  legal  definition  of  the  term  "nuisance."  Sanitary 
authorities  are  therefore  "  bound  to  provide  that  such  a 
state  shall  not  continue  through  want  of  proper  construc- 
tions for  the  drainage." 


AND  SEWEKAGE  ON  PUBLIC  HEALTH.  357 

SECTION  II. — SANITARY  ASPECTS  OF  THE  WATER- 
CARRIAGE  SYSTEM  OF  EXCRETAL  KEMOVAL. 

So  much  has  already  been  said  with  regard  to  the 
evils  resulting  from  collections  of  excretal  matter  in 
towns,  that,  at  first  sight,  the  superiority  of  any  system 
which  prevents  these  accumulations  would  appear  to 
be  placed  beyond  dispute.  Unfortunately,  however,  the 
sewer-system  is  by  no  means  free  from  serious  dangers, 
and  these  have  at  times  been  attended  with  such  disas- 
trous consequences  that  many  have  been  led  to  condemn 
it  altogether.  But  an  examination  of  a  few  of  the  more 
important  outbreaks  of  disease,  which  have  been  attributed 
to  the  introduction  of  sewers,  will  show  that  such  whole- 
sale condemnation  is  groundless ;  that  in  fact  such  out- 
breaks are  due  to  faults  in  the  system,  and  not  to  the 
system  itself.  Thus,  in  the  first  inquiry  of  Dr.  Buchanan, 
already  alluded  to  (Ninth  Report  of  the  Medical  Officer  to 
the  Privy  Council),  it  was  found  that  at  Chelmsford  the 
death-rate  from  enteric  fever  had  increased  since  the  in- 
troduction of  the  sewer-system  5  per  cent,  and  at  Worth- 
ing it  had  increased  23  per  cent.  In  both  these  places, 
however,  there  was  backing  up  of  the  sewage,  and,  as  a 
consequence,  the  sewer -gases  were  forced  up  into  the 
houses.  At  Chelmsford,  the  sewage  was  received  into 
a  tank  or  underground  well ;  and,  at  times,  when  the 
pumping -engine  was  not  at  work,  the  well  filled,  and 
choking  of  the  outfall-sewer,  and  flooding  of  the  cellars, 
ensued.  At  Worthing,  again,  although  there  was  not  so 
much  backing  up  of  the  sewage,  there  was  no  provision 
made  for  ventilation ;  and  hence,  in  the  outbreak  of 
1865,  the  disease  "almost  exclusively  attacked  the  well- 
to-do  occupants  of  houses  on  the  higher  levels,  where  the 
water-closets  were  inside  the  houses,  and  almost  entirely 
spared  the  houses,  mostly  of  a  much  poorer  sort,  situated 


358  EFFECTS  OF  IMPROVED  DRAINAGE 

on  lower  levels,  where  the  closet  was  placed  outside  the 
house.  It  was  not  so  in  the  times  of  cesspools ;  then 
these  low-lying  poor  houses  were  far  more  attacked  with 
fever  than  the  others."  At  Morpeth  it  was  also  observed 
that  occasional  outbreaks  of  enteric  fever  had  followed  times 
of  flood,  during  which  the  outfall  sewer  was  under  water. 
Other  instances  of  a  similar  character  might  easily 
be  multiplied,  but  these  are  sufficient  to  show  that  all 
such  outbreaks  are  due  either  to  faulty  construction, 
deficient  ventilation,  or  imperfect  flushing  of  sewers,  or  to 
backing  up  of  sewage  in  low-lying  towns.  But  while 
outbreaks  of  enteric  fever  do  occasionally  take  place 
through  the  agency,  of  sewers,  and  amongst  others  may 
be  mentioned  the  outbreak  at  Croydon  in  1875,  there 
was  no  point  more  clearly  established  in  the  whole  of 
Dr.  Buchanan's  inquiry  than -the  remarkable  reduction  of 
t)ie  death-rate  from  this  disease  which  had  taken  place  in 
almost  all  the  towns  where  a  proper  system  of  sewerage 
had  been  carried  out.  Thus,  in  nine  of  the  twenty-five 
towns  examined  the  diminution  in  the  number  of  deaths 
was  over  50  per  cent,  and  in  ten  others  from  33  to  50 
per  cent,  the  average  reduction  being  about  45  per  cent. 
The  same  kind  of  evidence  is  also  afforded  in  the  account 
of  the  sanitary  condition  of  Liverpool,  given  by  Dr. 
Trench  in  1868.  Dr.  Trench  wrote  : — In  1868  "there 
raged  a  wide -spread  epidemic  of  typhoid  fever  in  the 
town,  and  in  the  rural  districts  of  the  town.  .  .  .  While 
in  the  families  of  the  rich,  in  their  costly  suburban  dwell- 
ings, there  was  raging  a  fever,  clearly  and  unmistakably 
due  to  the  pestiferous  emanations  from  ill-drained  cess- 
pools, or  other  collections  of  filth  or  decomposing  organic 
matter ;  the  districts  in  the  borough  of  Liverpool  known 
as  the  fever  districts,  and  wherein  no  midden-steads  or 
cesspools  were  allowed  by  the  Council  to  remain  unaltered, 
continued,  during  the  whole  period  of  the  epidemic,  re- 
markably healthy  and  free  from  fever." 


AND  SEWEKAGE  ON  PUBLIC  HEALTH.  359 

As  regards  other  diseases,  it  appears  that  cholera 
epidemics  had  been  "  rendered  practically  harmless "  in 
all  of  the  twenty-five  towns  examined  by  Dr.  Buchanan ; 
and  in  the  majority  of  cases  the  death-rate  from  diarrhoea 
had  also  been  considerably  reduced.  Moreover,  the  general 
death-rate  was  lowered  in  some  towns  over  2  0  per  cent ; 
and  the  progress  made  by  the  inhabitants  in  cleanliness, 
decency,  and  self-respect,  was  found  to  be  as  striking  as 
the  improvement  in  their  health  measured  by  the  mortuary 
returns.  No  doubt,  the  improved  water-supply,  which 
was  generally  obtained  at  the  same  time,  aided  in  the 
common  health  -  amelioration ;  but  there  can  be  little 
question  that  the  system  of  excretal  removal  by  water- 
closets  and  sewers  was  the  real  agent  at  work.  But  un- 
less sewers  are  well  ventilated  and  kept  regularly  flushed, 
the  best  health  results  cannot  be  expected. 


SECTION  III. — SANITARY  ASPECTS  OF  SEWAGE 
IRRIGATION. 

It  has  already  been  shown  in  the  previous  chapter 
that  irrigation  is  the  only  method  of  sewage-disposal  which 
sufficiently  purifies  the  sewage,  and,  at  the  same  time, 
secures,  in  some  instances  at  least,  a  profitable  agricul- 
tural return.  It  now  remains  to  be  seen  whether  the 
carrying  out  of  the  system  is  attended  with  danger  to 
public  health.  And  here  it  may  be  premised  that  the 
same  difficulty  is  encountered  in  sifting  evidence  as 
throughout  the  whole  sewage  -  question, — the  difficulty, 
namely,  of  dealing  with  sweeping  generalisations  which 
have  been  based  on  isolated  or  exceptional  cases.  For 
while,  on  the  one  hand,  it  appears  that  Dr.  Letheby  and 
others  have  condemned  all  sewage  farms  as  pestilential 
swamps,  Dr.  Carpenter  of  Croydon  and  other  strenuous 


360  EFFECTS  OF  IMPROVED  DRAINAGE 

advocates  of  the  system,  so  far  from  pronouncing  them  as 
in  any  way  dangerous  to  health,  maintain  that  the  general 
health  of  the  neighbouring  inhabitants  is  actually  improved 
by  them.  But  this  is  pushing  the  argument  perhaps  too 
far  on  both  sides.  No  doubt  some  sewage  farms  answer 
to  Dr.  Letheby's  description,  especially  such  farms  as  have 
been  laid  out,  without  any  due  regard  to  drainage,  in  low- 
lying  districts,  and  those  that  have  been  planned  on  the 
"  catch  -  water "  system.  It  is  evident  that  this  latter 
system  necessitates  a  swampy  condition  of  both  soil  and 
subsoil,  unless  the  ground  is  porous  and  well  drained, 
inasmuch  as  the  sewage  passes  over  successive  areas  of 
land,  overflowing  from  each  into  a  "  catch-water "  ditch, 
which  conveys  it  to  the  next.  Again,  when  the  sewage 
is  not  delivered  in  a  fresh  state,  and  at  least  properly 
strained,  if  not  disinfected  by  some  precipitation  process, 
offensive  emanations  are  undoubtedly  given  off,  especially 
when  the  carriers  are  not  kept  clean.  But  though  all 
this  is  perfectly  true,  it  is  no  argument  against  the  system 
when  properly  carried  out,  unless  direct  evidence  can  be 
brought  forward  to  show  that,  even  when  the  engineering 
and  management  are  alike  satisfactory,  there  is  not  only 
possible  but  actual  risk  to  health.  Such  evidence,  how- 
ever, does  not  appear  to  be  forthcoming ;  and  even  with 
regard  to  farms  which  have  neither  been  planned  nor  are 
conducted  according  to  the  most  approved  principles,  the 
evidence  as  regards  the  production  of  disease  is  of  a  nega- 
tive character.  Thus,  Sir  Eobert  Christison  testified  con- 
cerning the  Craigentinny  Meadows,  near  Edinburgh — "  I 
am  satisfied  neither  typhus,  nor  enteric  fever,  nor  dysen- 
tery, nor  cholera,  is  to  be  encountered  in  or  around  them, 
whether  in  epidemic  or  non-epidemic  seasons,  more  than 
in  any  other  agricultural  district  of  the  neighbourhood  " — 
(First  Report  of  the  Rivers  Pollution  Commissioners).  At 
Norwood,  again,  where  the  farm  lies  on  a  deep  clay  soil, 


AND  SEWERAGE  ON  PUBLIC  HEALTH.  361 

Dr.  Cresswell  stated  that  the  health  of  the  neighbouring 
inhabitants  was  in  no  way  influenced  by  it ;  and  according 
to  the  Ninth  Eeport  of  the  Medical  Officer  of  the  Privy 
Council,  the  irrigation  works  at  "Worthing  did  not  cause 
any  description  of  nuisance  or  injury  to  health.  So  far, 
therefore,  the  production  of  disease  arising  from  fsecal 
pollution  of  air  or  water  by  the  system,  when  properly 
managed,  is  not  substantiated.  But  it  was  feared  at  one 
time  that  entozootic  diseases  would  be  greatly  propagated, 
no  matter  how  efficiently  the  system  might  be  carried  out, 
and  Dr.  Cobbold's  high  authority  gave  currency  to  the 
belief.  Dr.  Cobbold,  however,  with  rare  scientific  candour, 
and  after  careful  investigation,  has  since  stated  that  the 
fears  which  he  originally  entertained  have  not  been  real- 
ised. Animals  fed  on  sewage  produce  have  not  been 
found  to  be  parasitically  diseased,  nor  has  any  case  of 
parasitism  been  detected  in  man  which  could  be  traced 
to  the  effects  of  sewage-irrigation. 

Alarmists,  too,  have  not  been  wanting,  who  strenu- 
ously maintain  that  the  milk  of  cows  fed  on  sewaged 
grass  is  poor  in  quality,  rapidly  decomposes,  and  is  unfit 
to  be  used.  But  so  far  is  this  from  being  the  case,  that 
there  is  an  overwhelming  amount  of  evidence  to  the 
contrary ;  and,  amongst  other  instances,  I  may  mention  the 
following  :  Dr.  Brushfield,  formerly  of  Brookwood  Asylum, 
states  that  he  has  tried  the  experiment,  and  found  that 
cows  fed  on  sewaged  grass  yield  more  and  richer  milk 
than  cows  fed  on  ordinary  pasture,  and  this  is  also  the  ex- 
perience of  Mr.  Tough,  the  manager  of  Lord  Warwick's 
farm.  Further,  Dr.  Hill  of  Birmingham  and  Dr.  Swete  of 
Worcester,  have  frequently  analysed  both  milk  and  butter, 
and  with  the  most  satisfactory  results.  It  need  hardly 
be  said  that  on  a  well-conducted  sewage  farm,  no  sewage 
is  applied  for  several  days  before  the  grass  is  mown,  so 
that  it  is  always  perfectly  clean. 


362  PREVENTIVE  MEASURES DISINFECTION. 


^    wf  ^  . 

> 

ft      ^/**^-- 

VC-U 

CHAPTEK   XIV. 

PREVENTIVE  MEASURES — DISINFECTION. 

THE  remarks  in  this  chapter  will  have  reference  chiefly 
to  the  prevention  of  infectious  diseases,  and  to  the  adop- 
tion of  measures  best  calculated  to  check  their  progress 
when  they  become  epidemic,  or  threaten  to  become 
epidemic,  in  any  locality.  By  infectious  diseases  is  meant 
all  diseases  which  are  communicable  "from  one  person  to 
another,  whether  by  actual  contact  or  through  the  agency 
of  certain  media,  such  as  air  or  water.  Many  of  these, 
however,  are  comparatively  of  such  little  hygienic  concern, 
that  they  may  be  excluded  from  further  notice ;  as,  for 
example,  certain  parasitic  diseases  of  the  skin,  and  others, 
which  are  never  found  to  affect  communities  in  an 
epidemic  form.  The  preventive  measures,  therefore,  or 
other  protective  means,  which  will  be  here  considered, 
apply  mainly  to  the  class  of  diseases  termed  zymotic,  such 
as  smallpox,  cholera,  typhus  fever,  enteric  fever,  scarlet 
fever,  relapsing  fever,  measles,  and  the  like.  Although, 
in  preceding  chapters,  the  mode  of  propagation  of  several 
of  these  diseases  has  been  considered  more  or  less  fully 
in  detail,  it  will  nevertheless  be  of  advantage  to  allude 
very  briefly  to  some  of  the  opinions  which  are  entertained 
concerning  their  etiology.  •  According  to  the  germ  theory 
of  infectious  diseases,  the  origin,  de  now,  of  a  fever  poison 
is  as  impossible  as  the  spontaneous  generation  of  plants 
or  animals;  the  inference  being  that  enteric  fever,  for 


PKEVENTIVE  MEASURES DISINFECTION.  363 

example,  can  only  be  developed  from  the  specific  con- 
tagium  of  the  fever,  just  as  a  case  of  smallpox  cannot 
occur  without  infection  from  some  pre-existing  case.  Now, 
to  this  it  may  be  replied  that  the  poisons  of  all  the  acute 
specific  diseases  must  have  originated  at  one  time  or 
another  independently  of  pre-existing  cases,  and  there  is 
no  reason  to  believe,  therefore,  that  the  causes  which  led 
to  the  development  of  the  first  cases  should  not  be  in 
operation  at  the  present  day. 

As  regards  the  various  views  which  are  at  present 
entertained  with  respect  to  the  nature  oT  contagia  little  need 
be  said,  because  so  much  is  still  left  open  to  controversy. 
Some  maintain  that  the  particles  are  of  animal  origin, 
born  in,  and  only  growing  in,  the  body ;  in  other  words, 
that  they  are  minute  portions  of  bioplasm  endowed  with 
a  certain  amount  of  independent  life,  which  enables  them 
to  thrive  on  suitable  pabulum.  This  view  has  been  ably 
advocated  by  Dr.  Beale,  and  has  been  modified  by  Dr. 
Eichardson  under  the  name  of  the  glandular  origin  of 
disease.  Others,  such  as  Hallier,  maintain  that  the  par- 
ticles are  of  fungoid  nature,  and  simply  grow  in  the  body 
after  having  been  introduced  from  without ;  while  some 
of  the  most  careful  observers  hold  that  they  are  of  the 
nature  of  the  Schizomycetes,  such  as  Bacteria,  Microzymes, 
Bacilli,  Vibrios,  Monads,  etc.  No  doubt  these  minute 
organisms  are  intimately  associated  with  some  of  the  so- 
called  specific  diseases,  and  the  researches  of  Pasteur  on 
fowl-cholera  and  charbon  go  to  prove  that  these  two 
diseases  are  not  only  due  to  Bacteria,  but  that  they  can 
in  all  probability  be  prevented  or  modified  by  cultivated 
virus.  The  inquiries  into  the  wool -sorters'  disease  at 
Bradford  afford  further  evidence  that  it  is  identical  with 
the  anthrax  of  cattle,  in  which  the  Bacillus  anthracis 
plays  such  a  prominent  part,  while  Bacilli  were  found  to 
be  the  diagnostic  agents  in  the  poisoning  by  hams  at 


364  PREVENTIVE  MEASURES DISINFECTION. 

Welbeck  (see  Chapter  IL)  Koch's  researches  into  the 
nature  of  phthisis  have  also  associated  the  disease  with 
the  presence  of  well-defined  Bacilli.  But  the  very  uni- 
versality of  these  various  micro-organisms  affords  the 
strongest  argument  against  the  view  that  they  constitute 
the  contagia  of  any  of  the  specific  diseases,  and  there  are 
good  grounds  for  believing  that  further  pathological 
research  will  demonstrate  their  presence  in  the  blood  of 
patients  who  have  died  from  other  diseases. 

The  fact  is,  as  Dr.  Murchison  has  pointed  out,  the 
question  at  issue  has  been  discussed  on  too  narrow  a  basis, 
and  the  possibility  of  the  several  zymotic  diseases  differ- 
ing greatly  has  been  too  much  lost  sight  of.  Just  because 
all  of  them  are  infectious,  it  has  been  argued  that  none 
of  them  can  be  generated  except  by  a  specific  contagium. 
But  even  as  regards  this  infectious  quality,  there  is  the 
widest  possible  divergence  between  them ;  for  while,  on 
the  one  hand,  we  find  that  smallpox  and  scarlet  fever  are 
extremely  infectious,  we  find,  on  the  other,  that  enteric 
fever  and  erysipelas  have  only  a  limited  power  of  pro- 
pagating themselves,  except  under  insanitary  conditions 
which  are  favourable  to  their  development  and  spread. 
Moreover,  while,  in  regard  to  smallpox,  it  can  never  at 
the  present  day  be  traced  to  any  other  cause  than  infec- 
tion, in  diphtheria  it  is  comparatively  rarely  that  the  first 
case,  even  of  several,  can  be  traced  back  to  any  pre- 
existing case ;  and  the  same  remark  applies  generally  to 
sporadic  cases  or  limited  outbreaks  of  enteric  fever  as  they 
occur  in  rural  and  small  urban  districts.  Then,  again,  it 
is  a  matter  of  almost  daily  observation  that  pyaemia  and 
puerperal  fever  are  not  only  generated  de  now,  but  the 
researches,  more  especially  of  Dr.  Sanderson,  show  that 
they  can  be  generated  at  will,  and  when  so  generated  they 
become,  under  certain  circumstances,  eminently  infectious. 
It  is  no  argument,  therefore,  that  because  a  disease  is 


PREVENTIVE  MEASURES DISINFECTION.  365 

infectious  it  cannot  be  generated  de  now,  and  the  argu- 
ment becomes  weaker  still  when  it  is  remembered  that 
several  of  these  diseases  do  not  breed  true,  nor  do  they 
run  a  definite  course.  Thus  we  find  erysipelas  and  pyaemia 
running  into  each  other,  and  that  either  of  these,  or  scarlet 
fever  in  its  varied  forms,  may  generate  puerperal  fever  in 
the  parturient  woman.  Without,  however,  entering  further 
into  the  speculative  or  scientific  aspects  of  this  question, 
I  prefer  quoting  the  matured  views  of  Mr.  Simon.  After 
dilating  upon  the  influence  which  filth,  and  more  especi- 
ally excremental  filth,  exercises  in  the  development  and 
spread  of  diseases  such  as  cholera  and  enteric  fever,  which, 
in  respect  of  their  leading  symptom,  may  be  generalised 
as  diarrhoeal,  Mr.  Simon  continues — 

"  But  though  hitherto,  for  convenience  of  argument, 
I  have  referred  specially  to  the  influence  of  human  ex- 
crement in  determining  the  spread  of  '  specific '  infections 
from  man  to  man,  and  provisionally  as  if  man's  body 
were  the  sole  birthplace  of  the  several  contagia  which 
afflict  his  kind,  assuredly  that  intermediary  influence  is 
but  part,  and  it  may  be  but  a  very  subordinate  part,  of 
the  faculty  by  which  filth  produces  disease.  While  it  is 
indeed  true,  as  regards  some  contagia,  that  at  present  we 
know  them  only  as  incidents  of  the  human  body,  wherein 
we  see  them  in  case  after  case  multiplying  their  respec- 
tive types  with  a  successivity  as  definite  and  identical  as 
that  of  the  highest  orders  of  animal  or  vegetable  life, — 
and  while  thus  it  is  at  present  true,  for  instance,  of  small- 
pox or  syphilis,  that  a  case  arising  independently  of  a 
previous  like  case  is  hitherto  practically  as  unknown  to 
us  as  the  parentless  production  of  dog  or  cat,  our  know- 
ledge with  regard  to  other  very  important  contagia  is 
growing  to  be  of  larger  scope.  I  would  mention  it  as 
among  the  most  hopeful  advances  of  modern  preventive 
medicine,  that  some  diseases,  which,  in  the  sense  of  being 


366  PREVENTIVE  MEASURES DISINFECTION. 

able  to  continue  their  species  from  man  to  man,  are 
apparently  as  '  specific '  as  those  which  I  have  above 
named,  seem  now  beginning  to  confess  in  detail  a  birth- 
place exterior  to  man,  a  birthplace  amid  controllable 
conditions  in  the  physical  nature  which  is  around  us,  a 
birthplace  amid  the  '  common,'  putrefactive  changes  of 
dead  organic  matter.  Eeferring  again  now  to  what  I  have 
not  pretended  to  be  able  to  analyse  in  detail — the  excess 
of  miscellaneous,  and  in  great  part  nominally  '  common/ 
disease  in  filthy  neighbourhoods,  I  would  particularly  wish 
to  connect  with  that  subject  a  reference  to  our  growing 
scientific  knowledge  in  the  matter  of  the  '  common '  septic 
ferment.  The  pathological  studies  of  late  years,  including 
eminently  certain  very  instructive  researches  which  Pro- 
fessor Sanderson  has  conducted  under  my  Lords  of  the 
Council,  have  clearly  shown  that  in  the  '  common '  septic 
ferment,  or  in  some  ferment  or  ferments  not  hitherto  to 
be  separated  from  it,  there  reside  powers  of  disease- 
production  as  positive,  though  not  hitherto  as  exactly 
defined,  as  those  which  reside  in  the  variolous  and  syphi- 
litic contagia.  Experimentally  we  know  of  this  ferment, 
that,  when  it  is  enabled  by  artificial  inoculations  to  act  in 
its  most  effective  way  on  the  animal  body,  and  even  more 
when  it  has  received  a  curious  increment  of  strength  which 
its  first  propagation  within  the  living  body  seems  to  bestow 
on  it,  it  shows  itself  one  of  the  most  tremendous  of 
zymotic  poisons.  It  rapidly  in  the  one  animal  body  de- 
velops disease,  which  then  is  communicable  to  another : 
febrile  disease,  with  inflammations  numerous  and  intense, 
and  including  in  marked  degree  one  of  the  acutest  known 
forms  of  intestinal  inflammation  and  flux :  disease  exactly 
corresponding  to  certain  very  fatal  and  unfortunately  not 
unfrequent  infections  to  which  lying-in  women,  and  per- 
sons with  accidental  wounds  and  the  wounds  of  surgical 
operations,  are  most  subject,  but  which  also  sometimes 


PREVENTIVE  MEASURES DISINFECTION.  367 

occur  independently  of  such  exceptional  states  ;  infections, 
chiefly  known  under  the  names  of  erysipelas,  pyaemia, 
septicaemia  and  puerperal  fever ;  infections  which  we 
sometimes  see  locally  arising  anew  in  unquestionable 
dependence  on  filth,  but  of  some  of  which,  when  arisen,  it 
is  perfectly  well  known  that  they  are  among  the  most 
communicable  of  diseases.  And  a  further,  perhaps  still 
more  instructive,  teaching  of  the  artificial  infections  is 
this :  that  the  '  common '  ferment,  which  in  its  stronger 
actions  quickly  destroys  life  by  septicaemia,  can  in  slighter 
actions  start  in  the  infected  body  chronic  processes  which 
will  eventuate  in  general  tubercular  disease.  I  need 
hardly  point  out  that  the  above  facts,  extremely  suggestive 
though  they  are,  must  of.  course,  in  relation  to  my  main 
argument,  be  applied  only  under  certain  reserve ;  that 
evidently  the  exact  conditions  of  the  physiological  experi- 
ment are  not  reproduced  in  ordinary  life ;  and  that  against 
the  common  septic  ferment,  as  presented  in  fouled  atmo- 
sphere or  fouled  drinking  water,  the  living  human  body 
in  its  normal  state  can  apparently  make  considerable 
(though  presumably  not  unlimited)  resistance.  But  after 
all  such  reserves  the  truth  remains,  that,  looking  well  at 
the  pathology  of  human  life  under  residence  in  foul  air, 
we  find  ourselves  again  and  again  reminded  of  these  results 
of  physiological  experiment;  often  seeing  phthisis  and 
other  tubercular  and  like  diseases  gradually  developed,  as 
though  under  gradual  overpowering  of  the  limited  normal 
resistance  to  the  septic  ferment ;  or  seeing — and  particu- 
larly where  some  exceptional  bodily  state  (wounded  or 
puerperal)  gives  opportunity — the  sudden  invasion  of 
erysipelas  or  other  septic  infection,  not  in  discoverable 
dependence  on  any  human  infectant,  but  conceivably  a 
filth-inoculation  from  the  air.  The  line  of  reflection  thus 
suggested  is  one  which  I  cannot  now  follow  further,  but 
of  which  the  practical  interest  seems  to  be  extremely 


368  PREVENTIVE  MEASURES DISINFECTION. 

great.  For,  while  the  excessive  production  of  fatal  disease 
in  filthy  neighbourhoods  is  a  fact  as  to  which  there  can 
be  no  doubt,  and  of  which  the  immediate  significance  is 
deplorable,  the  ulterior  suggestion  is  this :  that  so  far  as 
filth  in  any  instance  produces  anew  such  a  disease  as 
erysipelas  or  puerperal  fever  on  the  one  hand,  or  phthisis 
or  other  tubercular  disease  on  the  other,  the  mischief  first 
done  is  of  a  sort  which  entails  certain  possibilities  of 
extension :  such,  namely,  that  in  the  one  instance  by 
accidental  contagion,  as  in  the  other  instance  by  heredi- 
tary transmission,  it  may,  for  aught  we  know,  indefinitely 
extend  beyond  the  sphere  in  which  filth  first  produced  it." 
— (See  Mr.  Simon's  Reports,  New  Series,  No.  II.) 

But  apart  from  the  influence  of  sanitary  defects  in 
the  development  and  spread  of  infectious  diseases/ and 
apart  also  from  the  influence  of  personal  susceptibility, 
which  as  regards  some  of  them  is  very  great,  there  are 
certain  other  influences  obscurely  called  epidemic,  which 
appear  to  act  as  predisposing  causes,  or,  at  all  events,  to 
give  increased  energy  to  causes  already  in  operation. 
Such  epidemic  influence,  however,  is  merely  the  expres- 
sion of  the  fact  that  we  cannot  always  explain  why  it  is 
that  certain  diseases  should  rage  with  terrible  violence  in 
a  particular  locality  at  one  time  and  not  at  another ;  or 
why  the  type  of  the  disease  should  now  be  mild  and  now 
severe ;  or  why  again,  a  disease,  such  as  cholera,  should 
be  subject  to  periods  of  pandemic  extension.  All  these 
are  questions  which  still  afford  ample  room  for  speculation 
and  research.  Meanwhile  it  is  encouraging  to  sanitary 
efforts  to  find  that  as  civilisation  advances,  epidemics  de- 
crease in  frequency  and  intensity,  and  that  nothing  tends 
so  much  to  weaken  their  power  and  circumscribe  their 
range  of  action,  as  a  free  circulation  of  pure  air  in  in- 
habited places,  a  good  supply  of  pure  water,  and  a  suffi- 
ciency of  wholesome  food. 


PREVENTIVE  MEASURES DISINFECTION.  369 

In  preceding  chapters  the  mode  of  propagation  of 
several  of  these  diseases  has  been  considered  more  or  less 
fully  in  detail.  It  has  been  shown,  for  example,  that 
there  is  good  reason  to  believe  that  the  contagia  of  cholera 
and  enteric  fever  are  contained  in  the  alvine  discharges, 
which,  in  their  turn,  pollute  the  water-supply  or  the 
respired  air ;  that  typhus  fever  is  essentially  a  disease  of 
overcrowding ;  and  that  relapsing  fever  is  associated  with 
wide-spread  insufficiency  of  food.  It  has  also  been  shown 
that,  when  the  local  circumstances  which  are  found  to 
favour  the  propagation  of  any  one  or  other  of  these  dis- 
eases in  an  epidemic  form  are  improved,  the  extension  of 
the  disease  is  checked,  and  its  ultimate  extinction  from  a 
portion  of  the  community  secured.  Improvement  of  local 
circumstances  is,  therefore,  a  most  important,  and  perhaps 
the  most  important,  part  of  prevention.  But  there  are 
other  measures  which  are  found  to  be  of  immense  service 
in  checking  the  course  of  any  epidemic, — such  as  the 
isolation  of  the  sick,  the  use  of  disinfectants,  and  the 
destruction  of  the  contagia  by  any  other  means  which 
may  be  deemed  most  efficacious.  In  order,  however,  to 
be  able  to  apply  these  measures  judiciously,  some  know- 
ledge of  the  mode  of  propagation  of  the  several  epidemic 
diseases  is  essential,  and  this  part  of  the  subject  may  be 
briefly  discussed  as  follows  : — 


SECTION  I. — MODE  OF  PROPAGATION  OF  EPIDEMIC  DIS- 
EASES, AND  THE  PRECAUTIONARY  MEASURES  INDI- 
CATED. 

1.  Cholera.  —  The  basis  of  precautionary  measures 
with  regard  to  this  disease  is  thus  described  by  Mr. 
Simon : — "  That,  when  cholera  is  epidemic  in  any  place, 
persons  who  are  suffering  from  the  epidemic  influence, 

2  B 


370  PEEVENTIVE  MEASURES DISINFECTION. 

though  perhaps  with  only  the  slightest  degree  of  diar- 
rhcea,  may,  if  they  migrate,  be  the  means  of  conveying 
to  other  places  an  infection  of  indefinite  severity;  that 
the  quality  of  infectiveness  belongs  particularly,  if  not 
exclusively,  to  the  matters  which  the  patient  discharges, 
by  purging  and  vomiting,  from  his  intestinal  canal ;  that 
the  matters  are  comparatively  non-infective  at  the  moment 
when  they  are  discharged,  but  subsequently,  while  under- 
going decomposition,  acquire  their  maximum  of  infective 
power;  that  choleraic  discharges,  if  cast  away. without 
previous  disinfection,  impart  their  own  infective  quality 
to  the  excremental  matters  with  which  they  mingle,  in 
drains  or  cesspools,  or  wherever  else  they  flow  or  soak, 
and  to  the  effluvia  which  those  matters  evolve;  that  if 
the  cholera-contagium,  by  leakage  or  soakage  from  drains 
or  cesspools,  or  otherwise,  gets  access,  even  in  small 
quantity,  to  wells  or  other  sources  of  drinking-water,  it 
infects,  in  the  most  dangerous  manner,  very  large  volumes 
of  the  fluid;  that  in  the  above-described  ways  even  a 
single  patient  with  slight  choleraic  diarrhoea  may  exert  a 
powerful  infective  influence  on  masses  of  population  among 
whom  perhaps  his  presence  is  unsuspected ;  that  things, 
such  as  bedding  and  clothing,  which  have  been  imbued 
with  choleraic  discharges,  and  not  afterwards  fully  disin- 
fected, may  long  retain  their  infectious  properties,  and  be 
the  means  of  exciting  choleraic  outbreaks  wherever  they 
are  sent  for  washing  or  other  purposes." — (Eighth  Report 
of  the  Medical  Officer  of  the  Privy  Council) 

The  practical  applications  of  the  above  remarks  are 
therefore  these, — that  the  alvine  discharges  and  vomited 
matters,  as  well  as  any  clothing  or  bedding  tainted  by 
them,  should  be  carefully  disinfected ;  and  that,  if  this  is 
carefully  attended  to,  there  is  little  or  no  risk  of  infection 
by  direct  contact  with  the  patient. 

It  would  be  out  of  place  here  to  refer,  except  in  the 


PREVENTIVE  MEASURES DISINFECTION.  371 

briefest  terms,  to  the  various  conflicting  doctrines  which 
have  been  advanced  with  regard  to  the  propagation  of  this 
disease.  Suffice  it  to  say,  that  while  Mr.  Simon's  views 
are  in  full  accordance  with  the  experience  of  those  who 
have  most  carefully  investigated  its  etiology  in  this 
country,  the  views  more  especially  of  Dr.  Cunningham, 
the  Sanitary  Commissioner  of  the  Government  of  India, 
are  so  entirely  opposed  to  them,  that  it  would  appear  as  if 
the  results  of  all  the  inquiries  which  have  been  so  carefully 
made  are  absolutely  worthless,  and  that  previous  inves- 
tigators have  been  on  the  wrong  track.  In  the  Ninth 
Annual  Sanitary  Eeport  to  the  Indian  Government,  he 
declares  in  effect,  on  the  evidence  of  108  outbreaks,  that 
the  transportability  of  cholera  by  persons  is  erroneous, 
that  the  water-spread  theory  of  the  disease  is  untenable, 
and  that  the  influence  of  tainted  air  cannot  be  at  present 
affirmed.  According  to  him,  so  little  is  known  about 
the  epidemic  extension  of  the  disease,  that  preventive 
measures  are  practically  of  little  or  no  value.  It  is  satis- 
factory to  note,  however,  that  even  in  India,  these  views 
are  already  beginning  to  receive  substantial  refutation; 
for  in  his  report  for  the  second  quarter  of  18*76,  Dr. 
Payne,  the  medical  officer  of  health  for  Calcutta,  shows 
clearly  that  though  other  insanitary  conditions  in  the 
native  parts  of  the  city  remain  unaltered,  the  introduction 
of  a  public  water-supply,  which  took  place  in  1870,  has 
been  followed  by  a  remarkable  and  continuous  diminution 
in  the  spread  of  cholera.  Pettenkofer's  views  have  already 
been  alluded  to  in  Chapters  VIII.  and  XIII. ;  and  those 
who  are  desirous  of  studying  the  European  relations  of 
the  disease,  should  read  the  elaborate  report  of  Mr.  Netten 
Eadcliffe,  and  the  abstract  by  Dr.  Seaton  of  the  proceedings 
of  the  International  Congress  held  at  Vienna  in  1874, 
both  of  which  are  contained  in  No.  V.  of ^  the  New  Series 
of  Mr.  Simon's  Reports. 


372  PREVENTIVE  MEASURES DISINFECTION. 

2.  Enteric  or  Typhoid  Fever. — That  this  disease  is 
essentially  a  filth-disease  is  alike  admitted  by  those  who 
accept  the  doctrine  of  Von  Gietl  and  Dr.  Budd,  and  those 
who,  like  Dr.  Murchison  and  Sir  William  Jenner,  maintain 
that  it  may  be  generated  independently  of  previous  cases. 
As  it  occurs  in  rural  and  small  urban  districts,  my  own 
experience  leads  me  to  believe  that  the  great  majority  of 
scattered  cases,  and  many  of  the  first  cases  of  isolated 
outbreaks,  are  due  to  poisoning  of  air,  drinking-water,  or 
other  ingesta,  with  decomposing  filth.  Most  frequently  it 
is  found  that  the  well-water  has  become  polluted  by  soak- 
age  from  some  drain,  cesspit,  or  manure  heap,  and  in  some 
instances  in  would  appear  as  if  ill-defined  forms  of  enteric 
fever,  such  as  those  vaguely  termed  low  fever,  gastric 
fever,  febricula,  and  the  like,  may  be  caused  by  decom- 
posing organic  matter  not  necessarily  faecal.  But  whether 
the  disease  is  produced  by  befouled  air  or  polluted  water, 
there  is  a  constantly  accumulating  amount  of  evidence 
which  goes  to  prove  that  neither  the  air  nor  the  water 
need  be  tainted  with  the  specific  contagium  of  the  disease. 
At  the  same  time,  there  is  no  fact  more  clearly  established 
in  preventive  medicine  than  this, — that  whenever  the 
disease  is  developed,  the  bowel  discharges  possess  an  in- 
fective power,  which,  where  local  conditions  assist,  can 
operate  with  terrible  force,  and  often  at  long  distances 
from  the  sick.  Indeed,  exclusive  of  the  epidemic  influ- 
ence, what  has  been  said  with  regard  to  the  infective 
power  and  the  mode  of  propagation  of  cholera  applies  to 
enteric  fever,  and,  in  the  main,  the  same  precautionary 
measures  (see  Appendix)  are  indicated.  The  evacuations, 
and  any  clothing  tainted  with  them,  should  be  thoroughly 
disinfected.  The  water-supply  should  be  examined,  and 
in  localities  where  the  sewer-system  has  been  introduced, 
the  condition  of  the  water-closets  and  drains,  with  regard 
to  ventilation,  flushing,  and  trapping,  should  be  carefully 


PREVENTIVE  MEASURES DISINFECTION.  3*73 

inquired  into.  Any  epidemic  of  enteric  fever  in  a  sewered 
town  points  to  imperfect  ventilation,  deficient  flushing,  or 
to  some  faulty  construction  of  the  sewers  or  drains,  or  to 
contamination  of  the  water-supply,  as  in  the  outbreaks  of 
Sherbourne,  Over  Darwen,  and  Lewes  (see  Chap.  VIII.) ; 
or  to  polluted  milk,  as  in  the  outbreaks  in  Marylebone, 
East  Moseley,  and  Eagley  (see  Chap.  II.)  In  villages 
and  country  districts  it  points  to  polluted  wells,  bad 
drainage,  or  filthy  privies,  all  of  which  may  originate  the 
disease  in  the  first  instance  as  well  as  be  the  means  of 
propagating  the  specific  contagium  when  it  is  developed 
or  introduced. 

If  proper  precautions  are  taken  there  is  little  or  no 
risk  that  the  disease  will  spread  to  persons  who  nurse  or 
otherwise  closely  attend  upon  the  sick. 

3.  Typhus  Fever. — The  conditions  essential  to  the 
propagation  of  typhus  fever  are  mainly  these :- — Over- 
crowding and  deficient  ventilation ;  clothing  saturated 
with  cutaneous  exhalations;  squalor  and  want;  a  deteri- 
orated state  of  the  constitution  from  whatever  causes; 
and  a  moderate  temperature.  'Si\&?  ^  u^  ^*2£T7 

The  disease,  once  generated,  is  highly  contagious,  the 
contagium  being  thrown  off  by  the  cutaneous  and  respi- 
ratory exhalations.  The  air  of  the  sick-room  is  therefore 
contaminated,  and  by  this  means  the  contagium  may 
attach  itself  to  the  walls  of  the  room,  or  to  furniture,  or 
to  bedding  and  clothing,  and  may  long  retain  its  efficacy 
if  fresh  air  is  excluded.  Cases  are  not  at  all  uncommon 
in  which  the  disease  has  been  communicated  to  persons 
who  have  been  employed  in  cleaning  out  places  which 
had  been  occupied  by  the  sick,  even  though  some  con- 
siderable time  had  elapsed  after  the  sick  had  been  re- 
moved. 

But  the  contagium  does  not  travel  far  through  the 
air,  for,  according  to  Dr.  Murchison's  observations,  it 


374  PREVENTIVE  MEASURES DISINFECTION. 

appears  that  if  a  patient  is  placed  in  a  well-ventilated 
room,  the  attendants  incur  little  risk,  and  the  other 
occupants  of  the  house  none  whatever.  Dr.  Eussell, 
medical  officer  of  health  for  the  City  of  Glasgow,  has  also 
reported  to  the  same  effect,  and  has,  in  addition,  deduced 
from  his  experience  other  points  of  practical  importance. 
Thus,  in  his  report  on  the  Fever  Hospital  for  1870,  he 
writes  :  "  All  these  facts  concur  in  proving  (1)  that, 
where  attention  is  paid  to  personal  and  general  cleanli- 
ness, typhus  does  not  carry  far,  so  to  speak,  through  the 
atmosphere,  and  is  not  portable;  (2)  close  approach  to, 
and  contact  with,  the  infected  individual  and  his  dirty 
belongings,  lead  with  great  certainty,  even  in  the  best 
sanitary  circumstances,  and  in  healthy  and  well-fed 
people,  to  an  attack  at  the  end  of  about  four  weeks  in 
the  great  majority  of  cases,  but  not  in  a  few  until  the 
lapse  of  some  months;  (3)  that  individual  susceptibility 
does  not  exist,  except  that  which  is  conferred  by  a  pre- 
vious attack." 

As  regards  the  period  of  the  disease  at  which  the 
contagium  is  most  powerful,  there  is  a  difference  of 
opinion.  According  to  Dr.  Murchison  the  disease  is 
most  readily  propagated  from  the  end  of  the  first  week 
up  to  convalescence — that  is,  during  the  period  when  the 
peculiar  typhus  smell  from  the  skin  and  lungs  is  the 
strongest. 

The  practical  deductions  from  these  observations  are 
as  follows : — The  sick  should  be  isolated  as  much  as 
possible;  the  attendants,  by  preference,  should  be  those 
who  have  been  protected  by  a  previous  attack ;  others 
who  visit  the  sick  should  avoid  coming  into  close  contact 
with  them ;  the  room  should  be  well  ventilated  by  open 
windows  and  fires  if  necessary ;  all  extraneous  furniture, 
such  as  carpets  and  curtains,  should  be  removed  and 
disinfected ;  disinfectants  should  be  constantly  used  in 


PREVENTIVE  MEASURES DISINFECTION.  375 

the  room ;  the  bedding  and  clothing  should  be  disinfected 
or  destroyed;  and  after  convalescence  the  whole  room, 
and  every  piece  of  furniture,  should  be  purified. 

4.  Relapsing  Fever. — Excluding  for  the  present  the 
consideration   of  the  public   measures  which  should  be 
adopted  when  an  epidemic  of  relapsing  fever  is  raging, 
the  hygiene  of  the  sick-room  should  be  conducted  in  the 
same  manner  as  in  the  case  of  typhus  fever.    The  disease, 
however,  is  much  less  frequent  than  typhus,  and  though 
contagious  in  the  same  way,  is  not  contagious  to  the  same 
extent.     It  selects  its  victims  from  the  poor  and  ill-fed, 
who  live  in  crowded,  un ventilated  buildings,  rather  than 
from  the  well-nourished,  whose  surroundings  are  healthy. 

5.  Smallpox. — "  There  is  no  contagion,"  wrote  the  late 
Sir  Thomas  Watson,  "  so  strong  and  sure  as  that  of  small- 
pox ;    none    that    operates   at   so   great    distance."     The 
contagium,  indeed,  may  be  wafted  from  house  to  house 
on  opposite  sides  of  a  street ;  and,  as  recent  inquiries  have 
shown,  it  may  be  conveyed  by  the  air  to  houses  in  the 
neighbourhood    of   smallpox    hospitals.      The    poisonous 
material  is  thrown  off  from  the  cutaneous  and  mucous 
surfaces  of  the  patient,  and  is  contained  in  the  exhalations, 
the  excretions,  the  secretions,  the  matters  in  the  vesicles 
and  pustules,  and  in  the  scabs.     It  contaminates  the  air 
of  the  sick-room,  and  attaches  itself,  as  in  typhus,  to 
everything  contained  in  the  room,  or  which  comes  in  con- 
tact with  the  patient.     Further,  it  is  possessed  of  great 
vitality,  and  if  protected  from  air  may  remain  active  for 
an  unknown  number  of  years.     The  period  of  incubation 
varies  from  ten  to  sixteen  days,  though  in  the  majority  of 
cases  it  does  not  exceed  fourteen.     The  patient  ought  not 
to  be  pronounced  free  from  infection  until  all  the  pustular 
crusts  have  fallen  off,  and  the  whole  surface  of  the  body 
has  been  well  sponged  with  water  and  some  disinfectant 
soap,  or  several  warm  baths  have  been  taken. 


3*76  PREVENTIVE  MEASURES DISINFECTION. 

Unfortunately,  as  regards  the  speedy  suppression  of 
outbreaks  of  this  disease,  it  not  unfrequently  happens  that 
the  first  few  cases,  if  of  a  modified  nature,  are  not  cor- 
rectly diagnosed,  the  disease  "being  mistaken  for  chicken- 
pox  or  measles.  In  my  own  district  I  have  had  to  report 
several  outbreaks  in  which  mistakes  of  this  description 
have  been  made,  and  I  have  also  been  consulted  in  a  few 
cases  when  the  disease  turned  out  not  to  be  smallpox,  as 
suspected,  but  either  measles  or  chicken-pox.  Of  course 
it  is  often  very  difficvilt  to  diagnose  with  certainty  an 
isolated  case  of  either  of  these  diseases,  and  hence  it  is 
very  essential  that  not  only  should  the  character  of  the 
eruption  be  carefully  scrutinised,  but  the  premonitory  and 
other  symptoms,  as  well  as  the  probable  source  of  infec- 
tion, should  also  be  carefully  inquired  into.  It  need 
hardly  be  said,  too,  that  until  the  nature  of  the  disease  is 
clearly  ascertained,  every  precaution  should  be  taken  as 
regards  isolation  and  other  preventive  measures.  Con- 
cerning the  protection  afforded  by  vaccination  and  re- 
vaccination,  as  well  as  other  rules  of  prevention,  see 
Appendix. 

The  stage  of  the  disease  at  which  the  poison  is  first 
generated  in  the  person  of  the  sick  is  not  accurately  de- 
termined, but  there  cannot  be  the  slightest  doubt  that,  so 
soon  as  a  case  is  diagnosed,  precautionary  measures  should 
forthwith  be  adopted.  If  the  patient  is  not  at  once  re- 
moved to  a  hospital,  he  should  be  carefully  isolated ;  those 
in  attendance  on  him  should  if  possible  be  protected  by  a 
previous  attack  of  smallpox  or  by  re- vaccination ;  and  the 
same  details  with  regard  to  the  hygiene  of  the  sick-room, 
disinfection,  etc.,  should  be  observed,  as  have  already  been 
insisted  on  in  cases  of  typhus.  All  persons  living  in  the 
same  house  or  adjoining  houses  over  twelve  years  of  age, 
should  at  once  be  re- vaccinated,  and  all  children  whose 
vaccination  marks  are  not  large  and  distinct. 


PREVENTIVE  MEASURES DISINFECTION.  3*77 

6.  Scarlet  Fever. — Although  this  disease  may  attack 
persons  of  all  ages,  it  specially  attacks  children  between 
the  third  and  fourth  year ;  after  the  fifth  year  the  chances 
of  attack  decline  rapidly.  The  contagium,  like  that  of 
smallpox,  is  exceedingly  powerful  and  volatile,  so  that  no 
susceptible  person  can  remain  in  the  same  room  for  any 
length  of  time,  or  even  in  the  same  house,  unless  the 
patient  is  carefully  isolated,  without  running  great  risk  of 
contracting  the  disease.  Moreover,  the  contagium  is  con- 
tained in  everything  which  proceeds  from  the  patient,  but 
more  especially  in  the  cuticular  scales  given  off  in  de- 
squamation.  These  scales,  laden  with  the  specific  poison, 
are  conveyed  by  the  currents  of  air  to  every  part  of  the 
room,  and  may  settle  on  clothing,  bedding,  furniture,  walls, 
etc.  They  preserve  their  virulence  for  an  unknown 
period  of  time,  and  when  disturbed  are  always  liable  to 
reproduce  the  disease.  Thus,  there  are  several  instances 
recorded  in  which  the  fever  has  been  contracted  by  sleep- 
ing in  a  room,  which  weeks  previously  had  been  occupied 
by  a  scarlet  fever  patient ;  and  the  fact  that  the  poison 
adheres  to  articles  of  clothing  is  proved  by  instances  in 
which  the  disease  has  been  propagated  by  the  clothing  of 
pupils  returning  home  from  school.  The  cases  already 
referred  to  in  the  chapter  on  water  impurities  are  also  of 
great  interest  in  showing  the  absolute  necessity  of  the 
utmost  care  and  cleanliness  to  be  observed  on  all  occa- 
sions, whether  the  attack  is  mild  or  severe.  In  the  vast 
majority  of  cases  a  previous  attack  confers  permanent 
immunity  from  the  disease. 

There  is  reason  to  believe  that  the  disease  is  infectious 
even  before  the  eruption  appears,  but,  according  to  my 
own  experience,  it  is  seldom  that  other  cases  break  out  in 
the  same  family  if  the  first  case  is  promptly  removed  to  a 
hospital,  and  proper  steps  are  taken  to  disinfect  the  house, 
etc.  The  patient  ought  not  to  be  pronounced  free  from 


378  PEEVENTIVE  MEASURES DISINFECTION. 

infection  until  desquamation  has  ceased,  and  the  surface 
of  the  body  has  been  well  bathed. 

The  precautionary  measures  which  are  indicated  by 
the  above  remarks  are  obvious ;  although  it  may  be  ad- 
mitted that  it  is  impossible  to  carry  them  out  efficiently 
in  the  crowded  homes  of  the  poorer  classes.  But  even  in 
homes  where  no  difficulty  should  be  experienced,  the 
necessary  isolation  and  disinfection  are  too  often  grossly 
neglected,  either  because  they  are  irksome,  or,  if  the  case 
is  slight,  because  they  are  considered  to  be  needless. 
With  regard  to  special  precautions,  see  Appendix. 

7.  Measles. — This  disease,  like  scarlet  fever,  is  emi- 
nently communicable.     The  contagium  may  be  conveyed 
by  fomites,  or  by  means  of  the  contaminated  air  of  the 
sick-room.     The  disease  attacks  persons  of  all  ages  and  of 
both  sexes,  but  is  much  more  frequent  amongst  children. 
The  risk  of  infecting  commences  with  the  primary  fever, 
and  is  greatest  when  the  specific  eruption  is  fully  deve- 
loped.    As  a  rule,  a  patient  who  has  once  suffered  from 
the  disease  is  no  longer  liable  to  a  second  attack. 

8.  Whooping-Cough. — The  susceptibility  to  this  dis- 
ease is  so  strong  that  few  persons  have  passed  the  age  of 
childhood  without  having  contracted  it.     Moreover,  the 
infecting  distance   of  the  contagium  appears  to  be  very 
considerable,  inasmuch  as  domestic  isolation  is  frequently 
found  to  be  of  little  avail  in  preventing  the  disease  from 
attacking  other  members  of  the  family  who  have  not  been 
protected  by  a  previous  illness.     That  the  contagium  may 
likewise  adhere  to  clothing,  and  may  in  this  way  propa- 
gate the  disease,  has  been  clearly  proved  by  numerous 
instances. 

Such  being  the  mode  of  propagation  of  measles  antl 
whooping-cough,  the  precautionary  measures  which  are 
indicated  comprise — isolation  of  the  patient,  if  other 
members  of  the  family  have  not  been  protected  by  a  pre- 


PKEVENTIVE  MEASURES DISINFECTION.  379 

vious  attack;  careful  attention  to  the  hygiene  of  the 
sick-room,  and  disinfection  of  the  clothing,  bedding,  etc. 
And  here  it  may  be  pointed  out  that  the  prevalence  of 
these  two  diseases  is  in  great  measure  attributable  to  the 
culpable  neglect,  arising  from  the  popular  belief,  amount- 
ing almost  to  fatalism,  that  children  must  contract  them 
some  time,  and  that  there  is  therefore  little  use  in  endea- 
vouring to  take  any  protective  steps  when  either  disease 
is  epidemic.  The  consequence  is  that  the  epidemic  con- 
tinues to  spread  so  long  as  susceptible  victims  are  to  be 
found  in  the  community,  and  only  dies  out  for  a  time 
when  almost  all  these  have  been  attacked.  How  far  the 
medical  profession  are  to  blame  in  allowing  this  popular 
delusion  to  retain  its  hold  on  the  public  mind  it  would 
be  difficult  to  say,  but  until  they  unite  in  striving  to  get 
rid  of  the  listless  apathy  which  it  engenders,  the  preva- 
lence of  such  epidemic  diseases  will  continue  to  be  an 
opprobrium  to  sanitary  science.  Nor  must  it  be  forgotten 
that  medical  men,  in  the  hurry  of  practice,  do  sometimes, 
though  unwittingly,  convey  the  contagium  of  an  infectious 
disease  from  one  patient  to  another.  For  example,  in- 
stances are  not  at  all  uncommon  in  which  scarlet  fever  has 
been  propagated  in  this  way,  and  the  records  of  puerperal 
fever  contain  the  histories  of  many  painful  cases  which 
could  never  have  occurred  had  greater  care  been  taken  to 
guard  against  such  fatal  mishaps. 

9.  Diphtheria. — Although  the  etiology  of  this  disease 
still  continues  to  afford  ample  scope  for  research,  there 
can  be  no  doubt  that,  in  its  origin  and  spread,  it  is  inti- 
mately associated  with  sanitary  defects.  In  the  majority 
of  the  sporadic  cases  which  have  come  under  my  own 
notice,  I  have  every  reason  to  believe  that  the  disease 
was  attributable  to  polluted  drinking-water,  though  in  a 
few  others  there  could  be  as  little  doubt  that  foul  effluvia 
from  cesspools,  drains,  and  the  like,  produced  the  malady. 


380  PREVENTIVE  MEASURES DISINFECTION. 

According  to  Dr.  Thursfield,  medical  officer  of  health  of 
the  Shropshire  Combined  District,  it  is  associated  with 
dampness  of  dwellings,  and  in  this  respect  may,  like  ague, 
be  largely  preventible  by  the  improvement  of  local  condi- 
tions. In  most  cases  the  severity  of  the  disease  is  directly 
influenced  by  the  conditions  under  which  the  person 
attacked  is  living ;  and  the  symptoms  become  greatly 
intensified  by  the  disease  passing  through  a  person  who 
has  newly  come  into  the  locality.  Diphtheria  is  more 
prevalent  in  rural  than  in  urban  districts,  and  although  it 
may  attack  adults,  it  is,  like  scarlatina,  a  disease  of  child- 
hood and  early  youth.  When  once  the  disease  becomes 
developed  it  is  eminently  infectious,  the  contagium  being 
given  off  principally  from  the  throat  and  breath,  although 
there  can  be  little  doubt  that  it  is  also  conveyed  by  the 
other  excretions,  and  may  thus  become  disseminated 
through  the  agency  of  sewers  or  closets.  In  a  household, 
and  among  children,  it  is  often  disseminated  by  kissing, 
and,  indeed,  the  greatest  care  ought  always  to  be  taken 
not  to  bend  over  the  patient  so  as  to  inhale  the  breath. 
Further,  there  can  be  no  doubt  that  the  infection  is  most 
portable,  and  may  be  conveyed  in  articles  of  clothing  and 
the  like,  but  the  opinion  that  it  may  be  wafted  long  dis- 
tances in  the  air  does  not  appear  to  be  well  corroborated. 
As  in  enteric  fever,  the  disease  may  be  spread  through 
the  agency  of  contaminated  milk ;  and,  according  to  Dr. 
Thursfield,  the  infection  can  be  taken  from  a  corpse,  or, 
at  least,  from  its  adjuncta.  Of  all  diseases,  not  even 
excepting  scarlatina,  this  is  the  one  most  liable  to  be 
disseminated  through  the  agency  of  schools,  partly  because 
the  symptoms  are  frequently  so  mild  as  not  to  prevent 
children  from  attending  school,  but  chiefly  because  the 
disease  is  peculiarly  liable  to  be  spread  by  the  breath, 
and  may  be  disseminated  by  the  throat  after  children  are 
sent  back  to  school  apparently  well.  There  can  be  no 


PEEVENTIVE  MEASURES DISINFECTION.  381 

doubt  that  the  agency  of  schools  in  the  spread  of  children's 
diseases,  such  as  scarlatina,  diphtheria,  and  measles,  is 
becoming  all  the  more  potent  as  attendance  becomes 
better  enforced;  but  now  that  Sanitary  Authorities  are 
empowered  to  close  schools  to  prevent  the  further  spread 
of  infectious  disease,  the  dangers  should  become  greatly 
lessened.  The  precautions  to  be  taken  in  respect 
to  diphtheria  are  much  the  same  as  those  which 
are  recommended  with  regard  to  scarlatina.  (See  Ap- 
pendix.) 

10.  Diarrhoea. — Although  many  are  inclined  to  dis- 
pute the  grounds  on  which  diarrhoea  is  classed  as  a 
zymotic  disease,  there  is  abundant  evidence  to  prove  that 
wherever  it  becomes  prevalent  it  is  due  in  large  measure 
to  insanitary  conditions,  and  that  so-called  summer  diar- 
rhoea is  often  as  distinctly  infectious  as  enteric  fever. 
No  doubt  there  is  a  considerable  amount  of  diarrhoea, 
especially  that  known  as  infantile  diarrhoea,  which  is  due 
to  hand-feeding  and  other  errors  in  diet;  but  according 
to  Dr.  Johnson  of  Leicester,  who  has  written  a  very 
exhaustive  paper  on  the  subject  (see  Sanitartf  Record, 
August  15,  1879),  out  of  the  238  deaths  which  he  in- 
vestigated, as  many  as  165,  or  69*3  per  cent  of  the  cases 
were  breast-fed.  As  is  well  known,  diarrhoea  has  been 
exceptionally  prevalent  in  recent  years  in  Leicester,  more 
particularly  during  the  summer  and  autumn  months,  and 
Dr.  Johnson  was  requested  by  the  Sanitary  Committee  to 
investigate  the  causes  of  the  origin  and  spread  of  the 
disease.  Dr.  Johnson,  in  his  painstaking  researches, 
ascertained  that  the  disease  was  not  limited  to  the  infan- 
tile portion  of  the  community,  nor  was  it  confined  to  the 
most  unhealthy  parts  of  the  town.  He  found,  however, 
that  after  a  period  of  warm  and  dry  weather,  the  appear- 
ance of  diarrhoea  is  hastened  ;  and  he  attributes  the  origin 
and  spread  of  the  disease  to  the  presence  of  bacteria  in 


382  PREVENTIVE  MEASURES DISINFECTION. 

sewer-air,  and  the  foul  effluvia  which  emanate  from  cess- 
pools, middens,  and  other  filthy  accumulations,  and  which 
find  a  ready  entrance  into  the  air  of  houses.  These 
bacteria  were  found  in  the  stale  food  of  infants  and  in 
the  juices  of  stale  or  over-ripe  fruit,  and  they  were  also 
detected  in  the  bowel-discharges  of  patients  affected  with 
the  disease.  He  therefore  concludes  that  badly- ventilated 
and  stagnant  sewers  constitute  an  important  factor  in  the 
causation  of  the  disease,  and  that  different  conditions  of 
drainage  account  largely  for  the  varying  prevalence  of 
diarrhoea  in  different  towns. 

In  these  remarks  on  the  mode  of  propagation  of  in- 
fectious disease,  it  has  been  assumed  throughout  that  the 
body  of  the  diseased  person  is  the  soil  in  which  the  germs 
or  infective  particles  of  the  disease  are  multiplied ;  that 
these  germs,  whatever  be  their  nature,  are  given  off  by 
the  patient,  and  may  contaminate  the  air,  drinking-water, 
or  other  ingesta,  or  may  adhere  to  clothing,  bedding,  fur- 
niture, or  walls  of  a  room ;  that,  either  directly  or  after 
remaining  dormant  for  an  unknown  period  of  time,  they 
may  infect  other  persons ;  and  that,  by  adopting  suitable 
measures  they  can  be  destroyed  altogether,  or  rendered 
inoperative  to  a  large  extent.  So  far  also  these  remarks 
have  had  special  reference  to  the  precautionary  measures 
which  form  a  part  of  personal  and  domestic  hygiene,  and 
which  fall  under  the  control  and  regulation  of  the  private 
medical  attendant.  The  general  proceedings,  which  should 
be  carried  out  under  the  advice  of  a  health  officer  in 
places  attacked  or  threatened  by  epidemic  disease,  are  set 
forth  in  an  official  memorandum  given  in  the  Appendix. 

SECTION  II. — DISINFECTANTS. 

In  the  wide  sense  of  the  word,  the  term  disinfectant 
may  be  defined  as  any  agent  which  oxidises  or  renders 


PREVENTIVE  MEASURES DISINFECTION.  383 

innocuous  decomposing  organic  matters  and  offensive 
gases,  which  arrests  decomposition,  or  which  prevents  the 
spread  of  infectious  diseases  by  destroying  their  specific 
contagia.  The  term,  therefore,  includes  any  agent  which 
possesses  deodorising,  antiseptic,  or  fixative  properties. 

Without  entering  into  any  discussion  on  the  modus 
operandi  of  disinfectants  generally  (because  the  subject  is 
still  under  dispute),  it  will  be  convenient  for  practical 
purposes  to  enumerate  and  describe  the  most  useful 
amongst  them  seriatim,  and  without  any  attempt  at 
classification. 

1.  Heat   and   Cold. — While   extreme   cold  prevents 
putrefactive  change,  and  therefore  acts  as  an  antiseptic, 
extreme  heat  is  destructive  of  all  organic  matter,  and  in 
this  respect  it  is  the  most  efficacious,  as  it  is  the  most 
ancient,  of  all  disinfectants.      But  even  a  temperature 
much  below  that  of  actual  combustion  is  found  to  be 
sufficiently  powerful,  if  continued  for  any  length  of  time, 
to  kill  animal  or  vegetable  germs,  and  to  render  inert  any 
contagious    matter.     Thus,  the  late  Dr.  Henry  proved 
experimentally  that  the  vaccine  virus  was  deprived  of  the 
power  of  reproduction  when  exposed  for  three  hours  to  a 
temperature  of  140°  Fahr.,  while  a  temperature  of   120° 
failed  to  produce  this  effect.     As  a  result  of  these  and 
other   experiments,  he  was  the  first  to  recommend  the 
employment  of  the  hot-air  chamber  to  disinfect  clothing, 
bedding,  and  the  like;  and  experience  has  proved  that, 
when  conducted  with  care,  the  plan  is  highly  successful. 
Among  disinfecting  stoves  which  have  been  found  to  work 
satisfactorily  may  be  mentioned  Dr.  Ransome's  self-regu- 
lating disinfecting  stove,  manufactured  by  Goddard  and 
Massey,  Nottingham  ;  the  patent  disinfecting  stove,  manu- 
factured by  Bradford  and  Co.,  Crescent  Iron  Works,  Sal- 
ford;  and  Dr.  Scott's  disinfecting  chamber. 

2.  Charcoal,  and  specially  animal  charcoal,  is  a  power- 


f      384  PREVENTIVE  MEASURES DISINFECTION. 

V/J    ful  deodorant,  but  there  is  no  evidence  to  show  that  it 
1 6  has  any  effect  in  destroying  specific  disease-germs.     It 
oxidises  offensive  organic  effluvia,  and  is  therefore  very 
useful   in  purifying   sewer -gases   or  other  filth   emana- 
tions. 

3.  Chlorine  decomposes  sulphuretted   hydrogen  and 
"°  ammonium  sulphide  more  certainly  than  any  other  gas, 

and  is  an  energetic  destroyer  of  all  organic  substances 
prone  to  decay.  It  is  especially  valuable  in  purifying 
rooms  which  have  been  occupied  by  persons  suffering 
from  infectious  diseases,  but  it  is  doubtful  whether  it  can 
be  of  much  service  in  the  hygiene  of  the  sick-room  itself, 
because,  even  when  largely  diluted,  it  is  very  irritating  to 
the  lungs.  It  is  given  off  in  small  quantities  by  chloride 
of  lime  moistened  with  water,  or  when  employed  in 
scrubbing  out  the  floor.  It  may  also  be  obtained  by 
adding  a  little  muriatic  acid  gradually  to  a  wine-glassful 
of  Condy's  fluid,  or  to  crystals  of  potassium  chlorate. 
When  required  in  large  quantity  for  the  disinfection  of 
empty  rooms,  it  is  most  rapidly  obtained  in  one  of  the 
following  ways  : — (1.)  To  equal  parts  of  common  salt  and 
binoxide  of  manganese  add  two  parts  of  water,  and  about 
the  same  amount  of  strong  sulphuric  acid.  (2.)  To  one 
part  of  powdered  binoxide  of  manganese  add  four  parts 
by  weight  of  strong  muriatic  acid.  (3.)  To  three  parts 
of  bleaching  powder  add  one  part  of  strong  sulphuric 
acid.  In  any  case,  the  quantities  required  will  depend 
upon  the  size  of  the  room. 

4.  Nitrous  Add. — Nitrous   fumes   are   obtained    by 
adding  strong  nitric  acid,  diluted  with  a  little  water,  to 
copper  filings.     The  power  of  oxidation  of  organic  matter 
possessed  by  nitrous  acid  is  very  great,  and  no  disinfectant 
will  more  readily  remove  the  offensive  smell  of  the  dead- 
house.     The  fumes,  however,  are  exceedingly  irritating 
and  dangerous, — so  much  so,  that"  this  process  of  disin- 


PREVENTIVE  MEASURES DISINFECTION.  385 

fection  is  only  suitable  for  empty  rooms,  and  under  skilled 
superintendence. 

5.  Iodine,  though  less  useful  than  chlorine,  has  been 
recommended   as   a   substitute   by   Dr.   Eichardson   and 
others.     It  is  a  powerful  antiseptic,  and  may  be  diffused 
through  the  air  of  a  room  by  placing  a  small  quantity  of 
the  substance  on  a  warm  plate,  but  it  is  not  suited  for  the 
sick-room. 

6.  Bromine. — The  vapour  of  bromine  can  be  obtained 
by  exposing  a  solution  of  bromine  in  potassium  bromide 
in  open  dishes.     It  was  largely  used  as  an  atmospheric 
disinfectant  during  the  American  War,  but  has  not  found 
much  favour  in  this  country. 

7.  Sulphur  Dioxide  or  Sulphurous  Acid  Gas. — This 
is  exceedingly  useful  for  disinfecting  empty  rooms.     It  is 
obtained  by  burning  sulphur  in  an  earthenware  pipkin  or 
other  vessel  that  will  not  readily  crack.     It  decomposes 
sulphuretted  hydrogen,  and  as  it  combines  with  ammonia, 
it  deodorises  or  destroys  stinking  alkaloids,  and,  probably, 
disease-germs.     Usually  fumigation   is   best   effected   by 
burning  about  1  Ib.  of  lumps  of  sulphur  for  every  thousand 
cubic  feet  of  space  in  an  iron  dish  (or  the  lid  of  an  iron 
saucepan)  supported  on  a  pair  of  tongs  over  a  bucket  of 
water.     In  a  long  room  it  is  advisable  to  burn  the  sul- 
phur in  one  or  two  places  in  order  to  secure  thorough 
disinfection. 

8.  Carbolic  Acid. — This  is  one  of  the  most  popular 
disinfectants,  and  is  especially  valuable  on  account  of  its 
highly  antiseptic  properties.     In   its  pure  state   it  is   a 
white  crystalline  solid,  which  in  a  diluted  form  has  been 
found  to  be  of  immense  service  in  preventing  putrefactive 
change  in  surgical  wounds.     The  commercial  article  is 
a  thin,  tarry  fluid,  possessing  a  somewhat  offensive  odour. 
It  is  highly  poisonous,  and  has  already  been  productive 
of  several  fatal  accidents,  on  account  of  its  having  been 

2  c 


386  PREVENTIVE  MEASURES DISINFECTION. 

mistaken  for  porter  or  other  fluids.  For  this  reason  the 
carbolic  acid  powder  is  safer  as  a  domestic  disinfectant. 
It  can  be  employed  in  scrubbing  out  floors,  in  steeping 
infected  clothing,  and  in  vessels  for  receiving  the  excreta. 
It  is  also  very  useful  in  disinfecting  urinals,  latrines, 
water-closets,  stables,  midden-heaps,  etc.  In  whatever 
form,  the  acid  is  destructive  of  the  low  forms  of  animal 
and  vegetable  life,  and  arrests  or  prevents  all  kinds  of 
putrefactive  change.  It  should  never  be  sprinkled  freely 
about  the  sick-room,  on  account  of  its  irritating  and  dis- 
agreeable odour. 

9.  Terebene. — This  disinfectant,  which  has  been  de- 
signed by  Dr.  Bond  of  Gloucester,  is  obtained  from  spirits 
of  turpentine.     It  has  a  fragrant  odour,  very  much  re- 
sembling that  of  pinewood,  and  is  powerfully  antiseptic. 
It  has  been  used  by  Professor  Maclean  at  the  Koyal 
Victoria  Hospital,  Netley,  with  excellent  effects,  in  cor- 
recting the  highly  offensive  evacuations  of  dysentery,  and 
the  fcetor  of  purulent  collections,  such  as  occur  in  cases 
of  liver  abscess  and  empyema,  while,  at  the  same  time,  it 
was  found  to  sweeten  the  air  of  the  wards  by  diffusing 
through  them  its  own  peculiar  pine-like  fragrance.     It  is 
especially  suited  as  a  deodorant  for  commodes,  and  as  a 
disinfectant  for  the  bowel-discharges  of  infectious  diseases. 
It  is  only  slightly  soluble  in  water,  but  it  mixes  readily 
with  sweet  oil  or  with  benzoline  for  use  in  surgical  dress- 
ings.   The  experience  of  its  effects  gained  at  Netley  shows 
that  it  is  peculiarly  suitable  for  use  in  Indian  hospitals 
and   in   hospitals  generally,  and   it  specially  commends 
itself  for  use  in  the  sick-room. 

10.  Oupralum  or  Terebene  Powder,  also  designed  by 
Dr.  Bond,  is  a  combination  of  terebene  with  cupric  sulphate 
and  potassic  bichromate,  and  possesses  the  same  agreeable 
odour.    It  neutralises  ammonia  and  sulphuretted  hydrogen, 
and  "acts  as  a  powerful  coagulator  of  albumen.     It  is 


PREVENTIVE  MEASURES DISINFECTION.    •         387 

specially  adapted  for  disinfecting  bowel-discharges,  water- 
closets,  urinals,  and  drains. 

11.  Sanitas  is  another  disinfectant  which  has  been 
highly  recommended.     It  is  manufactured  chiefly  from 
turpentine  and  water.    As  it  possesses  an  agreeable  odour, 
is  non-poisonous,  and  does  not  stain,  it  is  well  suited  for 
the  sick-room. 

12.  Condys  Fluid,  red  and  green,  consists  of  a  solu- 
tion  of  potassium  permanganate.     It  is   essentially  an 
oxidising  agent,  and  as  it  is  odourless,  it  is  a  very  valu- 
able disinfectant  in  the  sick-room. 

13.  Chloride   of  Aluminium,  or   "  Chloralum"   is   a 
powerful  disinfectant,  and  possesses  the  great  advantages 
of  being  non-poisonous,  inodorous,  and  very  cheap.     Pro- 
fessor   Wanklyn    says    that   "  for    removing    fcetor    and 
effluvia,  it  is  better  and  'more  available  than  any  agent 
with  which  I  am  acquainted.     In  this  respect  it  is  in- 
comparably superior  to  chloride  of  lime."     Dr.  Dougall, 
after  a  series  of  carefully-conducted  experiments,  likewise 
maintains  that  it  arrests  putrefactive  change,  and  prevents 
the  appearance  of  animalculse  to  a  greater  extent  than 
any  of  the  commonly  employed  disinfectants.     Not  being 
volatile,  it  cannot  be  regarded  as  an  aerial  disinfectant, 
but  it  is  exceedingly  useful  in  washing  infected  clothing, 
or  as  a  scouring  material  for  cleansing  rooms.     It  is  also 
an  excellent  sewage  deodorant. 

14.  Chloride  of  Lime  is  very  useful  for  disinfecting 
drains  and  faecal  matters. 

15.  M'Dougall's  Powder  consists  of  carbonate  of  lime 
and   magnesium   sulphite.     Like  Calvert's  carbolic   acid 
powder,   it   may   be   employed  very  advantageously  for 
cleansing  purposes,  and  for  the  disinfection  of  masses  of 
putrescent  matter,  sewage,  or  excreta. 

16.  Sidphate  of  Copper  has  been  recommended   by 
Dr.  Dougall  as  possessing  antiseptic  properties  equal  to 


388  PREVENTIVE  MEASURES DISINFECTION. 

those  of  chloralum ;  but  it  is  not  so  suitable  on  account 
of  its  price  and  poisonous  nature. 

1 7.  Chloride  of  Zinc. — "  Burnett's  solution  "  consists 
of  25  grains  of  this  salt  to  every  .fluid  drachm.     It  de- 
stroys ammoniacal  compounds  and  organic  matter.    When 
used,  it  should  be  diluted  with  eight  times  its  bulk  of . 
water. 

18.  Ferrous  Sulphate   or    Green  Copperas  has    been 
largely  used  for  disinfecting  heaps  of  manure  and  sewage. 
It  has  also  been  recommended  by  Pettenkofer  to  be  added 
to  cholera  evacuations  for  the  purpose  of  destroying  the 
contagium ;  but  it  does  not  appear  to  have  been  attended 
with  any  good  results. 

19.  Jeye's  Disinfectant  is  very  useful  for  disinfecting 
excreta  or  drains,  and  is  a  powerful  deodoriser. 

Other  sewage  disinfectants  have  already  been  de- 
scribed in  the  chapter  on  the  Purification  of  Sewage. 

20.  Cooper's  Salts,  which  consist  of  a  compound  of 
sodium,  calcium,  and  magnesium  chlorides,  have  also  been 
recommended  as  street  and  sewer  disinfectants. 

21.  Potassium  Bichromate  has  been  extolled  by  Dr. 
Angus  Smith,  and  chromic  acid  by  Dr.  Dougall,  as  being 
powerful  antiseptics,  but  it  is  doubtful  whether  their  price 
will  ever  permit  of  their  being  largely  employed. 

Although  the  names  of  other  agents  could  be  added 
to  this  list,  it  embraces  all  the  more  useful  disinfectants, 
and  several  which,  while  they  are  useful,  are  not  so 
common.  Probably  the  most  reliable  amongst  them  may 
be  enumerated  as  follows : — heat,  sulphurous  acid,  car- 
bolic acid,  Condy's  fluid,  chloralum,  ferrous  sulphate, 
chloride  of  zinc,  chloride  of  lime,  M'Dougall's  and  Cal- 
vert's  powders,  terebene,  cupralum,  sanitas,  charcoal,  and 
Jeye's  disinfectants. 


PREVENTIVE  MEASURES DISINFECTION.  389 


SECTION  III. — PRACTICAL  DISINFECTION. 

1.  Hygiene  of  the  Sick-room. — In  all  cases  of  highly 
infectious  disease,  if  the  patient  is  not  removed  to  a 
hospital,  the  first  duty  to  be  attended  to  is  the  enforce- 
ment of  a  strict  domestic  quarantine  by  isolation  of  the 
patient  whenever  it  is  possible ;  the  next  point  is  to 
make  certain  that  the  room  is  well  lighted  and  sufficiently 
ventilated  by  means  of  open  windows,  and  fires  if  neces- 
sary ;  and  the  third  point  is  to  require  the  instant  re- 
moval of  all  extraneous  furniture,  such  as  carpets,  curtains, 
and  the  like.  The  attendant  on  the  patient  should  receive 
strict  and  precise  injunctions,  not  only  with  regard  to  the 
nursing  of  the  patient,  but  also  with  regard  to  the  main- 
tenance of  the  utmost  cleanliness  in  the  room ;  the  dis- 
infection of  excreta,  slops,  soiled  linen,  etc.,  and  their 
immediate  removal  afterwards ;  and  other  points  of  detail 
depending  upon  the  special  nature  of  the  disease  and  the 
circumstances  of  the  patient. 

Although  aerial  disinfectantsv  may  be  regarded  as  of 
doubtful  efficacy  in  the  sick-room,  they  are  deemed  to 
be  useful  or  expedient  by  many ;  and,  when  properly 
selected  and  managed,  it  may  be  said,  at  all  events,  that 
they  do  not  do  any  harm,  if  they  are  not  productive  of 
much  good.  The  great  danger  is,  that  when  employed 
without  due  precaution,  they  may  only  serve  to  disguise 
the  signs  of  insufficient  ventilation,  and  in  this  way  con- 
duce to  inattention  as  regards  this  most  essential  point. 
If  they  are  employed  at  all,  they  should  not  be  irritating 
to  the  patient.  Hanging  rags  steeped  in  disinfectant 
solutions  about  the  room  is  not  to  be  commended,  but  a 
sheet  moistened  with  a  strong  solution  of  chloralurn, 
sanitas,  cupralum,  or  Condy's  fluid,  and  suspended  out- 
side the  door  of  the  room,  is  advantageous  to  complete 


390  PREVENTIVE  MEASURES  — DISINFECTION. 

the  isolation  of  the  patient.  The  infected  clothing,  etc., 
should  be  received  into  a  tub  containing  chloralum,  san- 
itas,  or  carbolic  acid,  and  the  ejecta,  etc.,  should  be  in- 
stantly covered  with  one  or  other  of  these  disinfectants 
and  removed.  Care  must  also  be  taken,  in  using  different 
disinfectants,  that  they  do  not  counteract  each  other ;  for 
example,  carbolic  acid  decomposes  Condy's  fluid.  Further, 
the  inunction  of  the  body  of  the  patient,  in  certain  of  the 
exanthematous  infectious  diseases,  and  especially  scarlet 
fever,  with  camphorated  oil,  or  a  mixture  of  terebene  and 
sweet  oil,  or  a  weak  solution  of  glycerine  and  carbolic 
acid,  followed  by  disinfecting  baths  during  convalescence, 
is  attended  with  the  best  results. 

2.  Disinfection   of  Empty   Rooms    and    Uninhabited 
Places. — After   a   case    of   infectious   disease,   the   room 
should   be    thoroughly   cleansed    and   disinfected.      The 
furniture   should   be  washed  with  a  strong   solution   of 
chloralum  (three  or  four  ounces  to  the  gallon  of  water), 
or  with  carbolic  acid  or  terebene  soap,  and  the  room,  as 
far  as  possible,  emptied.     Afterwards  the  floor  and  wood- 
work should  also  be  thoroughly  washed  with  disinfectant 
soap,  and  the  paper  should  be  removed.     After  closing 
doors,  windows,  and  other  openings,  sulphurous  acid  gas 
should  be  generate^  in  large  quantities  in  the  manner 
already  described,  and  the  room  kept  closed  for  several 
hours.     After   this,   the   door   and   windows    should    be 
thrown  open,  and  in  a  few  days  the  ceiling  should  be 
washed  with  quick  lime  and  whitened,  the  walls  repapered, 
and   the   floor   and  wood-work  thoroughly  washed  with 
water  and  some  disinfectant  soap. 

3.  Disinfection  of  Clothing,  Bedding,  etc. — Any  mate- 
rial of  this  description  which  cannot  be  injured  by  being 
washed,  should  be  steeped  in  a  solution  of  chloralum  or 
carbolic  acid,  and  boiled.     If  Condy's  fluid  be  used,  the 
material    should    merely   be    immersed,   and    afterwards 


1'KEYENTIVE  MEASURE* DISINFECTION.  391 

rinsed  out  in  cold  water,  otherwise  the  solution  will 
stain.  In  all  cases,  however,  when  it  can  be  carried  out, 
the  clothing,  bedding,  etc.,  are  best  disinfected  by  being 
exposed  for  an  hour  at  least  to  a  dry  heat  of  about  240° 
or  250°  Fahr.,  and  for  this  purpose  every  town  of  any 
dimensions  should  be  provided  with  a  hot-air  disinfecting 
chamber  for  public  use.  Such  a  chamber  is  built  of  brick, 
and  is  heated  by  a  coil  of  hot-air  pipes  lying  underneath 
a  perforated  grating,  and  communicating  with  a  furnace 
which  opens  outside.  The  one  in  use  in  Dublin  cost 
£400.  Dr.  Kansome  of  Nottingham,  as  already  stated, 
has  devised  a  specially  constructed  disinfecting  chamber, 
which,  while  it  secures  a  sufficiency  of  heat,  prevents  the 
articles  from  being  scorched.  In  connection  with  every 
such  chamber  in  large  towns  there  should  be  a  covered 
van  or  hand-cart  for  conveying  infected  articles,  and  great 
care  should  be  taken,  by  the  free  use  of  disinfectants,  or 
by  wrapping  the  articles  in  a  sheet  moistened  with  a 
strong  disinfecting  solution,  to  prevent  any  risk  of  spread- 
ing disease.  A  small  portable  disinfecting  chamber  is 
much  needed  for  rural  districts. 

The  hair  of  infected  mattresses  should  be  teased  out, 
fumigated,  and  exposed  to  the  air,  if  the  mattresses  cannot 
be  disinfected  in  a  hot-air  chamber.  Eags  and  other 
articles  which  can  be  spared  should  be  destroyed  by  fire, 
but  so  as  not  to  create  nuisance.  When  clothing  cannot 
be  disinfected  by  heat,  Dr.  Kansome  has  proposed  that 
the  different  articles  should  be  placed,  layer  on  layer,  in  a 
box,  with  hot  sand  or  bricks  placed  at  the  bottom,  and 
sprinkled  over  with  carbolic  acid ;  but  a  better  plan  is  to 
hang  them  up  in  a  small  room  and  disinfect  them  with 
sulphurous  acid  gas. 

4.  Disinfection  of  Water-Closets,  Urinals,  Sinks,  etc. — 
In  any  district  where  an  epidemic  prevails  or  is  threaten- 
ing, disinfection  of  all  water-closets,  etc.,  should  be  carried 


392  PREVENTIVE  MEASURES DISINFECTION. 

on  systematically,  either  with  solutions  of  chloride  of 
lime,  chloralum,  cupralum,  carbolic  acid,  copperas,  or 
Burnett's  fluid.  Cooper's  salts  might  be  used  for  the 
streets,  lanes,  and  open  courts.  Any  manure-heaps  or 
other  accumulations  of  filth,  which  it  is  inexpedient  to 
disturb  or  impossible  to  remove,  should  be  covered  with 
powdered  vegetable  charcoal  to  the  depth  of  two  or  three 
inches,  or  with  a  layer  of  fresh  dry  earth,  or  with  freshly- 
burnt  lime,  if  charcoal  cannot  be  obtained.  Cesspits  and 
midden-heaps  may  be  disinfected  with  solutions  of  cop- 
peras (3  Ibs.  to  the  gallon  of  water),  or  with  cupralum  or 
chloralum  (1  Ib.  to  the  gallon  of  water).  It  need  hardly 
be  said,  however,  that  in  a  town  or  district  well  looked 
after  by  the  sanitary  authorities,  no  such  filth-accumula- 
tions would  be  allowed  to  take  place  at  any  time. 

5.  Disinfection  of  the  Dead  Body. — When  a  patient 
dies  of  a  highly  infectious  disease,  such  as  smallpox  or 
scarlatina  maligna,  the  body  should  be  washed  with  a  very 
strong  solution  of  carbolic  acid  or  chloralum,  or,  better 
still,  enveloped  in  a  sheet  saturated  with  such  solution, 
and  placed  in  the  coffin  as  soon  as  possible,  disinfectants 
being  again  freely  used,  and  the  lid  screwed  down.  The 
burial  should  take  place  without  delay ;  or  in  crowded 
districts,  and  in  towns  where  a  mortuary  is  provided,  the 
dead  body  should  be  at  once  removed  thither.  The  linen 
worn  by  the  patient  at  death,  if  not  buried  with  the  body, 
should  be  destroyed  by  fire ;  but  when  this  cannot  be 
done  without  creating  nuisance,  the  burning  should  be 
effected  at  some  distance  from  houses,  or  the  bedding 
may  be  saturated  with  quicklime,  and  buried. 

It  may  be  urged  that  many  of  these  directions  are 
needlessly  minute ;  and  that,  in  fact,  they  cannot  possibly 
be  carried  out  in  perhaps  the  great  majority  of  cases.  In 
answer  to  such  objections  let  it  be  said,  once  and  for  all, 
that  no  labour  is  wasted  which  aims  at  preventing  the 


PREVENTIVE  MEASURES DISINFECTION.  393 

spread  of  disease,  even  though  it  be  often  attended  with 
failure ;  and  that,  however  limited  be  the  means  or  oppor- 
tunity of  carrying  out  preventive  or  precautionary  mea- 
sures, such  means  and  such  opportunity  should  always 
be  used,  so  as  to  be  productive  of  the  best  possible  results 
under  the  circumstances.  Although  a  number  of  disin- 
fectants have  been  mentioned,  it  is  always  advisable  that 
only  a  few,  and  those  deemed  the  most  efficient,  should 
be  used.  Thus,  for  use  in  the  sick-room,  terebene  or 
sanitas  appears  to  be  one  of  the  most  suitable ;  for  steep- 
ing clothing,  a  solution  of  carbolic  acid  or  sanitas ;  for 
disinfecting  drains,  closets,  etc.,  chloride  of  lime,  Jeye's 
disinfectant,  or  carbolic  acid  powder ;  and  for  fumigation, 
sulphurous  acid  gas.  For  more  special  directions,  see 
Appendix. 


94  VITAL  STATISTICS. 


CHAPTEE   XV. 

VITAL  STATISTICS. 

VITAL  statistics  may  be  defined  as  the  science  of  figures 
applied  to  the  health-history  of  communities.  They  deal 
with  the  principal  events  or  phenomena  of  human  life, — 
the  births,  marriages,  and  deaths ;  the  various  diseases 
from  which  people  suffer  or  die,  together  with  all  the 
influences  which  affect  vitality.  In  other  words,  the  units 
of  which  they  are  composed  consist  mainly  of  persons 
living  and  of  persons  dying,  and  these  units  are  classified 
or  grouped  under  certain  definite  characteristics,  such  as 
age,  sex,  occupation,  and  disease.  The  analysis  of  these 
units  or  elementary  facts,  observed  in  their  various  rela- 
tions to  time  and  place,  and  dealt  with  according  to  strict 
numerical  method,  lies  at  the  foundation  of  all  sound 
inquiry,  and  supplies  the  only  true  criterion  of  sanitary 
progress. 

SECTION  I. — SOURCES  OF  INFORMATION. 

In  briefly  discussing  this  subject  for  the  purposes  of  the 
health  officer  or  sanitarian,  it  will  be  convenient  to  refer 
at  the  outset  to  the  two  main  sources  from  which  the  data 
which  constitute  vital  statistics  are  derived,  namely,  the 
census  returns,  and  the  returns  of  births,  marriages,  and 
deaths,  supplied  by  registration.  As  all  these  returns 
particularise  the  locality  of  every  unit,  whether  supplied 


VITAL  STATISTICS.  395 

by  census  or  registration,  the  units  themselves  can  be 
readily  classified  according  to  various  divisions  or  sub- 
divisions of  the  country,  such  as  counties,  towns,  unions, 
parishes,  villages,  or  streets,  or  according  to  urban  and 
rural  districts,  as  defined  by  the  Public  Health  Act, 
1875.  For  purposes  of  registration  the  country  is 
divided  into  registration  and  sub -registration  districts, 
which  bear  a  more  or  less  definite  relation  to  counties, 
towns,  and  unions ;  while  for  sanitary  purposes  the  par- 
ticular returns,  which  apply  to  every  district,  however 
small  or  however  large,  can  be  obtained  by  every  sanitary 
authority  throughout  the  country  from  the  district  regis- 
trars. The  management  of  the  census,  and  the  entire 
charge  of  the  vital  statistics  of  the  United  Kingdom,  are 
entrusted  to  three  Registrars-General,  viz.  one  for  Eng- 
land and  Wales,  one  for  Scotland,  and  one  for  Ireland, 
who  publish  yearly  and  quarterly  reports  for  the  whole 
country,  and  weekly  reports  for  certain  large  towns. 

1.  The  Census. — The  census,  or  actual  enumeration 
of  the  people,  is  effected  in  Great  Britain  every  ten  years. 
The  first  enumeration  was  made  on  March  10,  1801, 
and  the  last  on  April  4,  1881,  so  that  the  recent  census 
was  the  ninth  enumeration  of  the  inhabitants  of  this 
country.  In  order  to  secure  accuracy  of  returns  it  is 
essential  that  the  census  should  be  taken  rapidly  and 
simultaneously ;  and  this  is  effected  by  issuing  schedules 
to  every  householder  beforehand,  who  has  to  enter  all  the 
particulars  concerning  every  one  sleeping  in  the  house- 
hold on  the  night  of  the  date  fixed  for  the  census.  These 
schedules  are  all  scrutinised  and  collected  on  the  follow- 
ing day  by  the  appointed  enumerators,  and  in  due  course 
forwarded  to  the  office  of  the  Kegistrar-General,  where 
they  are  tabulated  and  made  available  for  statistical 
purposes. 

It  need  hardly  be  said  that  the  taking  of  a  census 


396 


VITAL  STATISTICS. 


does  not  consist  merely  of  a  simple  enumeration  of  the 
people.  Amongst  other  items,  the  schedule  returns  con- 
tain particulars  of  the  name,  sex,  age,  rank,  profession  or 
occupation,  condition,  relation"  to  head  of  family,  and 
birthplace  of  every  living  person  who  passed  the  night 
of  the  date  of  the  enumeration  in  every  house  throughout 
the  kingdom.  When  these  returns  are  fully  classified 
and  analysed,  they  not  only  give  the  -number  of  inhabited 
and  uninhabited  houses  in  every  parish,  town,  union,  or 
county  throughout  the  kingdom,  together  with  the  number 
of  inhabitants,  but  the  population  can  be  grouped  accord- 
ing to  ages,  sex,  occupation,  etc.,  thus  supplying  a  vast 
storehouse  of  statistical  information,  which  is  of  the 
highest  value. 

The  following  table,  from  the  Preliminary  Keport  of 
the  1881  Census,  is  interesting,  as  showing  the  growth  of 
the  population  of  England  and  Wales,  and  the  enormous 
increase  in  the  population  of  London,  during  the  present 
century : — 


Year  of  Enumeration. 

Population  in  England  and  Wales  and  in  London  at 
the  Nine  Enumerations. 

England  and 
Wales,  j 

London. 

Persons  in  London 
to  100  in  England 
and  Wales. 

1801       .     .     . 

8,892,536 
10,164,256 
12,000,236 
13,896,797 
15,914,148 
17,927,609 
20,066,224 
22,712,266 
25,968,286 

958,863 
1,138,815 
1,378,947 
1,654,994 
1,948,417 
2,362,236 
2,803,989 
3,254,260 
3,814,571 

10-78 
11-20 
11-49 
11-91 
12-24 
1318 
13-97 
14-33 
14-69 

1811      
1821      
1831      

1841      
1851 

1861      

1871 

1881 

The  aggregate  population  of  England  and  Wales  at 
the  last  census,  including  the  population  of  London,  con- 
sisted of  12,624,754  males  and  13,343,532  females,  show- 


VITAL  STATISTICS.  397 

ing  an  excess  of  females  over  males  of  718,778.  Further, 
it  is  shown  that  the  rate  of  increase  in  the  aggregate 
population  is  almost  entirely  dependent  upon  two  factors, 
namely,  the  birth-rate  and  the  death-rate ;  the  effects  of 
emigration,  immigration,  or  other  movements  of  the  popu- 
lation, being  found  to  be  comparatively  insignificant.  The 
rapid  growth  of  the  past  decennium  was  also  ascertained 
on  analysis  to  be  due  to  the  fact  that  the  birth-rate  was 
unusually  high,  while  the  death-rate  was  much  below 
the  average.  This  is  shown  in  the  following  table,  which 
applies  to  England  and  Wales : — 

•    Mean  Annual  Mean  Annual 

Birth-rate.  Death-rate. 

1841-1851 32-61  22 '33 

1851-1861 34-15  22  '25 

1861-1871 35-24  22 '50 

1871-1881 35-35  21 '27 

In  the  words  of  the  report,  "  the  higher  birth-rate  in 
1871-81,  as  compared  with  the  preceding  decade,  im- 
plies the  addition  of  26,774  extra  members  to  the  com- 
munity ;  while  the  lower  death-rate  implies  the  survival 
of  299,385  persons  who,  with  the  previous  rate  of  mor- 
tality, would  have  died." 

What  is  called  "  the  natural  increment  of  the  people  " 
is  represented  by  the  excess  of  births  over  deaths,  while 
the  "  actual  increment "  can  of  course  only  be  determined 
by  enumeration.  During  the  last  decennial  period  the 
difference  between  the  natural  and  actual  increment  only 
amounted  to  0*74  per  cent,  the  former  representing  an 
increase  of  15*08  per  cent  upon  the  population  at  the 
beginning  of  the  period,  while  the  latter  represented  an 
increase  of  14' 3 4  per  cent. 

The   following   table    gives    the    population    of   the 
United  Kingdom  at  the  censuses  1851-81  inclusive: — 


398 


VITAL  STATISTICS. 


1851 

1861 

1871 

1881 

United  Kingdom      . 

27,745,949 

29,321,288 

31,845,379 

35,246,562 

England    .... 

16,921,888 

18,954,444 

21,495,131 

24,608,391 

Wales  

1,005,721 

1,111,780 

1,217,135 

1,359,895 

Scotland    .... 

2,888,742 

3,062,294 

3,360,018 

3,734,370 

Ireland      .... 

6,574,278 

5,798,967 

5,412,377 

5,159,839 

Isle  of  Man    .     .     . 

52,387 

52,469 

54,042 

53,492 

Channel  Islands  .     . 

90,739 

90,978 

90,596 

87,731 

Army,    Navy,    and  "j 
Merchant  Seamen  V 

212,194 

250,356 

216,080 

242,844 

abroad  .     .     .     .  J 

2.  Calculated  Estimates  of  Population. — Having 
pointed  out  so  much  concerning  the  actual  census  of  the 
people,  it  becomes  necessary  now  to  refer  to  the  method 
of  estimating  populations  adopted  by  the  Kegistrar- 
General  for  years  intervening  between  one  census  enume- 
ration and  the  next.  This  method  of  calculation  is  based, 
as  regards'  the  country  generally,  and  large  and  growing 
populations,  on  the  assumption  that  the  rate  of  increase 
which  prevailed  Between  the  last  two  census  enumera- 
tions will  be  maintained  until  the  next  census  is  taken. 
The  estimate  of  the  population  of  a  town  or  sanitary  dis- 
trict thus  obtained  becomes  the  basis  upon  which  the 
birth-rate,  death-rate,  and  other  rates  are  calculated,  and 
it  need  hardly  be  said  that  the  nearer  the  estimate  ap- 
proaches the  actual  number  of  the  population  the  more 
strictly  reliable  will  be  the  statistical  results.  The 
method  pursued  by  the  Eegistrar-General  requires  the 
use  of  logarithms,  and  is  lucidly  described  in  a  leading 
article  in  the  Sanitary  Record  for  March  1879.  In  the 
article  in  question  the  population  of  Sheffield  is  dealt 
with  by  way  of  illustration,  and  this  is  stated  as  amount- 
ing to  185,172  at  the  census  of  1861,  and  239,947  at 
that  of  1871,  giving  an  increase  of  54,775  persons 


VITAL  STATISTICS.  399 

during  the  intervening  period.     The  article  then  goes  on 
to  show  that  "  the  rate  of  increase  can  most  conveniently 
and  most  simply  be  calculated  by  the  aid  of  logarithms. 
Instead  of  taking  the  difference  between  the  population 
enumerated  in   1861  and   1871,  the  difference  between 
the  logarithms  of  these  numbers  affords  the  true  method 
for  ascertaining  the  rate  of  increase.     The  logarithm  of 
the  population  of  Sheffield  in  1861  is  5*2675753,  and 
that  of  the  population  in  1871  is  5*3801136  ;  the  dif- 
ference between  these  logarithms  is  0*1125383,  which 
is  the  logarithm  of  the  rate  of  increase  of  population  in 
Sheffield  during  the  ten  years  1861-71.    If  this  logarithm 
of  the  rate  of  increase  be  added  to  the  logarithm  of  the 
population  in  1871,  the  number  corresponding  to  this 
new  logarithm  will  be  the  estimate  of  the  population  at 
the   next  census  in  1881,  which  will  be  found  to  be 
310,922  (or  70,975  more  than  the  enumerated  popula- 
tion in  1871).     Having  obtained  the  logarithm  of  the 
ten  years'  increase  (0 '1125383),  a  tenth  of  this  will  give 
us  the  logarithm  of  the  annual  rate  of  increase ;  by  in- 
serting a  cypher  to  the  left  of  the  logarithm  we  shall 
divide  it  by  10,  and  0*0112538  will  be  the  logarithm 
of  the  annual  rate  of  increase.     The  Eegistrar-General 
usually  estimates  his  populations,  for  calculation  purposes, 
to  the  middle  of  the  year,  and  as  the  census  is  taken  at 
the  end  of  March  or  the  beginning  of  April,  a  quarter  of 
the  logarithm  of  the  annual  rate  has  to  be  added  to  the 
logarithm  of  the  enumerated  population   to   obtain  the 
logarithm  of  the  estimate  for  the  middle  of  the  year  1871. 
The  logarithm  of  the  annual  rate  in  Sheffield  divided  by 
4  gives  0*0028135,  which,  added  to  the  logarithm  of  the 
enumerated  population  in   1871,  gives  the  logarithm  of 
the  population  in  the  middle  of  1871,  namely,  5*3829271. 
Having  thus  obtained  the  logarithm  of  the  population  in 
the  middle  of  1871,  the  successive  addition  thereto  of 


400  VITAL  STATISTICS. 

the  logarithm  of  the  annual  rate  of  increase  (0-0112538) 
will  give  the  logarithm  of  the  population  in  the  middle  of 
1872,  1873,  and  so  on  up  to  the  middle  of  1881,  by 
which  time  a  new  census  will  give  us  a  new  starting- 
point.  The  addition  of  eight  and  a  quarter  times  the 
logarithm  of  the  annual  rate  of  increase  to  the  logarithm 
of  the  enumerated  population  of  Sheffield  in  1871  gives 
the  logarithm  5 '4  729575,  the  number  to  which  is 
297,138;  this  is  the  Eegistrar-General's  estimate  of  the 
population  of  the  borough  of  Sheffield  in  the  middle  of 
this  year. 

"  The  reverse  operation,  that  is,  deducting  the  loga- 
rithm of  the  annual  rate  of  increase  from  the  logarithm 
of  the  estimated  population  in  the  middle  of  1871,  will 
give  the  logarithm  of  the  population  in  the  middle  of 
1870  ;  and  by  repeating  this  operation  the  logarithm  of 
the  populations  in  the  middle  of  each  of  the  years  back 
to  1861  may  be  obtained." 

It  may  be  interesting  to  note  here  that  though  the 
estimate  of  the  population  of  Sheffield  in  1881  was 
310,922,  the  actual  population  as  enumerated  at  the 
census  of  that  year  was  only  284,410,  showing  that  the 
rate  of  increase  which  prevailed  during  1861-71  was  not 
maintained  during  the  last  decennial  period.  But  unless 
the  census  is  taken  at  shorter  intervals,  this  discrepancy 
between  the  calculated  and  the  actual  increase  of  large 
towns  cannot  well  be  avoided. 

In  small  and  slowly-increasing  districts  the  following 
method  of  calculation  will  give  a  fairly  approximate  esti- 
mate of  the  population.  Add  to  the  population  of  the 
district  as  enumerated  at  the  last  census  a  tenth  of  the 
difference  between  that  number  and  the  number  obtained 
at  the  previous  census  for  each  year  that  has  elapsed 
since  the  last  census.  This  will  give  the  estimated  popu- 
lation for  the  end  of  the  first  quarter  of  any  given  year, 


VITAL  STATISTICS.  401 

that  being  the  period  of  the  year  at  which  the  census  is 
taken.  But  inasmuch  as  the  death-rate  is  calculated  on 
the  estimated  population  of  the  district  at  the  close  of  the 
second  quarter  or  middle  of  any  year,  it  is  evident  that  a 
fourth  part  of  the  annual  increment,  or  a  fortieth  part  of 
the  actual  increase,  of  population  which  has  taken  place 
between  the  two  censuses  must  be  added  to  represent  the 
increment  for  the  additional  quarter. 

As  regards  new  and  rapidly-increasing  districts,  how- 
ever, this  method  of  calculation  will  not  apply,  and  in 
such  cases  it  is  desirable,  when  possible,  to  ascertain  the 
number  of  inhabited  houses  for  the  year,  which  may 
generally  be  obtained  from  the  assessment  books.  An 
approximately  correct  estimate  of  the  population  can  then 
be  obtained  by  multiplying  the  average  number  of  in- 
habitants per  house,  which  can  be  ascertained  without 
much  trouble,  by  the  number  of  occupied  houses. 

2.  Registration. — Ever  since  the  days  of  Queen 
Elizabeth,  births,  deaths,  and  marriages  have  been  regis- 
tered in  the  different  parishes  throughout  England ;  but 
it  was  not  till  the  year  1837  that  the  Legislature  passed 
an  Act  which  provided  that  for  the  future  all  these  entries 
should  find  a  place  in  a  national  register,  and  that  as 
regards  deaths  the  various  causes  or  diseases  should  be 
certified  by  the  medical  attendant.  That  the  important 
office  of  the  Kegistrar- General  of  England,  which  was 
established  by  that  Act,  has  been  productive  of  a  vast 
amount  of  benefit  to  the  health  of  the  nation,  and  indeed 
has  largely  stimulated  other  countries  to  follow  in  the 
wake  of  sanitary  progress,  there  can  be  no  doubt.  The 
first  annual  report  of  the  Eegistrar-General,  which  was 
drawn  up  by  the  late  Dr.  Farr,  appeared  in  1839,  and 
from  the  date  of  his  appointment  as  Superintendent  of 
the  Statistical  Department  up  to  the  date  of  his  retire^ 
ment  in  1879,  his  was  the  master-mind  which,  by  a  wide 

2  D 


402  VITAL  STATISTICS. 

yet  accurate  induction  from  statistical  data,  laid  the 
foundations  of  public  hygiene,  and  at  the  same  time 
enlarged  and  established  the  principles  of  medical  science. 
In  England  and  Wales  there  are  over  two  thousand 
registrars  and  superintendent-registrars,  whose  duty  it  is 
to  collect  and  forward  to  the  central  office  at  Somerset 
House  all  the  certificates  returned  to  them  throughout 
the  country.  These,  as  already  stated,  apply  to  births, 
marriages,  and  deaths. 

a.  Registration  of  Births. — The  chief  data  in  these 
returns  are  the  sex,  the  date  of  birth,  the  place  of  birth, 
the  number  of  births  (twins  or  triplets),  legitimacy,  and 
the  residence  of  the  parents. 

b.  Registration  of  Marriages. — These  returns  give  the 
name,  age,  occupation,  residence,  and  condition  of  husband 
and  wife. 

c.  Registration   of  Deaths.  —  The    principal   data   in 
these   returns    are   the   date,  name,   residence,  age,  sex, 
occupation,  condition  (whether  single,  married,  or  widowed), 
and  the  fatal  disease  or  cause  of  death. 

In  the  case  of  children  the  age  is  stated  in  days, 
weeks,  or  months  up  to  two  years.  But  of  all  the  data 
the  most  important  to  the  hygienist  is  the  cause  of  death, 
which  has  to  be  certified  by  the  medical  attendant,  or,  in 
cases  of  inquest,  by  the  coroner.  To  ensure  accuracy  of 
statistical  results  it  is  highly  essential  that  the  cause  of 
death  should  be  clearly  diagnosed,  and  certified  according 
to  the  nomenclature  of  diseases  drawn  up  by  the  Eoyal 
College  of  Physicians,  and  adopted  by  the  Eegistrar- 
General.  But  it  must  be  confessed  that,  apart  from  errors 
in  diagnosis,  which  frequently  occur,  the  cause  of  death 
is  too  often  certified  in  a  haphazard  sort  of  way,  and  with 
but  little  regard  to  correct  medical  terminology.  As  a 
rule,  however,  these  inaccuracies  apply  for  the  most  part 
to  causes  of  disease  which  do  not  come  under  sanitary 


VITAL  STATISTICS.  403 

control ;  and  in  this  respect,  therefore,  they  do  not  vitiate 
statistical  results  to  any  appreciable  extent,  except  when 
the  primary  cause  of  death  is  not  certified.  For  example, 
a  case  of  enteric  fever  often  succumbs  to  pneumonia ;  a 
case  of  scarlatina  to  nephritis ;  a  case  of  measles  or 
whooping-cough  to  bronchitis;  a  case  of  phthisis  to 
diarrhoea ;  a  case  of  rheumatic  fever  to  endocarditis — 
and  so  on.  Now,  in  all  such  cases  it  is  of  the  utmost 
importance  that  the  primary  cause  should  be  certified  as 
well  as  the  secondary,  because  the  former  is  the  cause 
which  should  be  classified  as  the  actual  cause  of  death. 
Accuracy  of  data,  uniformity  of  data,  and  completeness  of 
data,  are  all  of  them  indispensable  to  correct  statistical 
analysis. 

But,  in  addition  to  the  registration  of  deaths,  it  has 
long  been  urged  by  leading  sanitary  reformers,  that  no 
true  estimate  of  the  vitality  of  the  nation  can  be  formed, 
unless  a  national  system  of  registration  of  cases  of  sick- 
ness is  also  established.  It  is  true  that  to  a  certain 
limited  extent  this  has  been  attempted  by  the  Local 
Government  Board,  by  issuing  instructions  to  clerks  of 
unions  to  furnish  weekly  returns  of  all  new  cases  of  sick- 
ness occurring  among  paupers,  whether  in-door  or  out- 
door, to  the  medical  officers  of  health  of  their  respective 
districts ;  but  the  information  thus  supplied  is  often  of  a 
very  incomplete  kind,  and  except,  as  regards  cases  of  fever 
or  infectious  disease,  is  practically  of  little  value.  Of  far 
greater  importance  is  it  for  purposes  of  sanitary  defence 
that  some  system  of  compulsory  notification  of  all  cases 
of  dangerous  infectious  disease  should  be  adopted  for  the 
country  generally,  such  as  is  now  in  force  in  several  large 
towns,  because  without  prompt  information  of  early  cases, 
preventive  measures  are  often  of  little  avail,  and  especially 
in  districts  where  proper  hospital  accommodation  has 
been  provided. 


404  VITAL  STATISTICS. 


SECTION  II. — CLASSIFICATION. 

The  data  thus  obtained  are  classified  or  grouped  under 
various  headings.  For  example,  so  far  as  the  duties  of 
the  medical  officer  of  health  are  concerned,  the  births  are 
classified  according  to  sex,  while  the  deaths  are  classified 
according  to  sex,  ages,  and  diseases.  In  large  urban  dis- 
tricts the  system  of  classification  usually  adopted  is  that 
of  the  Kegis trar- General,  ^but  for  small  urban  or  rural 
districts  the  limited  tabular  returns  required  by  the  Local 
Government  Board  will  be  sufficient.  In  either  case, 
however,  printed  forms  should  be  used  for  classification, 
and  arranged  to  contain  all  the  data  for  weeks,  months, 
or  quarters. 

In  classifying  data  of  any  kind,  it  is  essential  that 
the  individual  units  should  have  precise  and  definite 
characters,  so  that  every  unit  in  a  group  should  be  strictly 
included  in  that  group.  Then,  again,  the  dividing  char- 
acter of  every  group  should  be  so  distinct  and  clearly 
defined  as  to  afford  no  room  for  doubt  under  which  group 
or  heading  every  unit  should  be  classified.  Care  also 
should  be  taken  that  no  unit  should  be  classified  so  as  to 
appear  in  two  allied  groups  at  the  same  time.  Thus,  we 
will  suppose  that  a  death  has  been  returned  as  due  to 
phthisis  as  the  primary,  and  diarrhoea  as  the  secondary, 
cause ;  it  would  obviously  vitiate  the  results  if  the  single 
case  were  classified  under  the  heading  of  diarrhoea,  and 
also  under  that  of  phthisis. 

SECTION  III. — STATISTICAL  EESULTS. 

After  the  data  or  units  have  been  correctly  classified, 
it  becomes  possible  to  compare  and  discuss  their  numerical 
relations.  For  this  purpose  a  constant  numerical  standard 


VITAL  STATISTICS. 


405 


must  be  adopted,  and  in  vital  statistics  it  is  the  rule  to 
state  this  relation  or  rate  as  so  inuch  per  cent  or  per 
1000,  or  some  other  multiple  of  1000. 

1.  Birth-Rate.  —  The  birth-rate  of  a  population  or 
community  is  obtained  by  comparing  the  total  number  of 
births  occurring  in  a  year  and  the  total  population  esti- 
mated, as  previously  shown,  at  the  middle  of  the  same 
year.  It  is  usual  to  represent  it  as  a  rate  per  1000  of 
the  population  living  in  the  district,  at  all  ages.  Thus, 
we  will  suppose  that  the  estimated  population  of  a  dis- 
trict is  11,902,  and  that  the  number  of  births  registered 
in  the  district  during  the  year  amounted  to  384,  then  the 
birth-rate  is  obtained  as  follows  :  — 


11,902  :  1000  :  :  384  :  X, 
or  annual  birth-rate  per  1000  =  —  ,, 


=  3  2  '2. 


The  rate  of  illegitimate  births  is  generally  represented  as 
a  percentage  of  the  total  number  of  births.  Thus,  the 
total  number  of  births  registered  in  England  and  Wales 
during  1880  amounted  to  881,643,  of  which  number 
42,542  were  born  illegitimate,  being  in  the  proportion  of 
4*  8  to  every  100  children  born. 

Male  births  are  everywhere  more  numerous  than 
female,'  but  in  England  and  Wales  the  proportion  of  boys 
to  girls  is  smaller  than  in  any  other  European  country. 
This  is  shown  in  the  following  table  from  the  Eegistrar- 
General's  Eeport  for  1880,  which  gives  the  average 
number  of  male  births  to  100  female  births,  for  the 
ten  years  1870-79  :  — 


Italy 
Austria 
France 
Switzerland 
German  Empire 


107-1 
106-8 
106-4 
106-3 
106-2 


Holland    .         .         .  .106-1 

Belgium    .         .         .  .105-9 

Scotland  .         .         .  .     1057 

Ireland      .         .         .  .     105 '6 

England  and  Wales  .  .     103'9 


406 


VITAL  STATISTICS. 


The  following  table  gives  the  mean  annual  birth- 
rate in  England  and  "Wales,  and  other  European  States, 
during  the  period  1876-80  : — 

MEAN  ANNUAL  BIRTHS  PER  1000  PERSONS  LIVING, 
1876-1880. 


COUNTRIES. 

Mean  Annual 
Birth-rate 
1876-80. 

COUNTRIES. 

Mean  Annual 
Birth-ratel 
1876-80. 

England  and  Wales 
Denmark    .... 
Sweden  . 

35-4 
31-9 
30-2 

Switzerland  .  .  . 
German  Empire  .  . 
The  Netherlands 

31-3 
39'3 
36'4 

Austria  .... 
Hungary 

39-1 
43'6 

Belgium  .... 
Italy  

32-0 
36'6 

The  high  birth-rates  which  prevail  in  large  urban 
districts  are  in  great  measure  due  to'  the  fact  that  the 
marriage-rate  is  higher,  and  that  women  marry  younger 
than  they  do  in  country  districts;  while  another  cause 
which  no  doubt"  operates  to  a  considerable  extent  is  the 
high  rate  of  infant  mortality,  thus  shortening  the  intervals 
of  child-bearing,  by  the  early  deaths  of  the  new-born.  In 
fashionable  towns,  where  large  numbers  of  unmarried  ser- 
vants are  employed,  and  where  a  large  proportion  of  the  resi- 
dents are  retired  people,  the  birth-rate  is  always  very  low. 

2.  Marriage-Rate. — This,  like  the  birth-rate,  is  usually 
calculated  as  a  rate  of  persons  marrying  per  1000  of  the 
population  living  in  the  middle  of  the  year.    The  marriage- 
rate  in  England  and  Wales  during   1879  was  14*4  per 
1000  of  the  population,  while  the   average  of  the  ten 
years  1871-80  was  16'1  per  1000. 

3.  Mortality. 

(1.)  Total  Annual  Death-Rate. — What  is  called  the 
general  death-rate,  or  total  annual  death-rate,  of  any  dis- 
trict or  community,  is  determined  by  means  of  a  ratio 


VITAL  STATISTICS.  40  7 

between  the  number  of  deaths  occurring  during  the  year 
and  the  estimated  population  in  the  middle  of  the  year, 
and,  like  the  birth-rate,  is  represented  as  a  rate  of  so 
many  deaths  per  1000  of  the  estimated  population. 
Thus,  we  will  suppose  that  the  estimated  population  of 
a  district  amounts  to  22,151,  and  that  the  number  of 
deaths  which  occurred  in  the  district  during  the  year 
amounted  to  335,  then  the  total  annual  death-rate  would 
be  calculated  as  follows  : — 

22,151  :  1000  :  :  335  :  X, 
or  X  =   00 '         =  15*1,  where   X  represents   the    total 

2>  J,  10 1 

annual  death-rate  per  1000. 

In  the  great  majority  of  sanitary  districts  with  com- 
paratively small  populations,  the  total  annual  death-rate 
does  not  represent  the  actual  death-rate,  and  corrections 
must  be  made  for  deaths  of  persons  not  belonging  to.  the 
district,  which  occur  in  hospitals,  workhouses,  asylums, 
or  among  visitors,  and  for  the  deaths  of  persons  belonging 
to  the  district  which  occur  outside  the  district.  Take, 
for  example,  the  statistics  of  a  town  of  some  10,000 
inhabitants  in  the  centre  of  a  union  of  some  45,000 
inhabitants.  The  town  is  a  separate  sanitary  district, 
but  contains  the  workhouse  for  the  whole  union.  It  is 
evident  that  the  death-rate  for  the  town  would  be  repre- 
sented as  larger  than  it  really  is  if  no  correction  were 
made  for  the  deaths  which  occur  in  the  workhouse ; 
while,  on  the  other  hand,  the  death-rate  of  the  surround- 
ing rural  district  would  appear  less  than  it  actually  is, 
unless  the  quota  of  in-door  pauper  deaths  belonging  to  it 
is  added  to  the  total  number  of  deaths.  To  make  these 
corrections,  the  statistics  of  deaths  occurring  in  these  in- 
stitutions, giving  full  particulars  of  age,  sex,  and  residence, 
must  be  obtained.  In  populous  urban  districts,  however, 


408  VITAL  STATISTICS. 

if  the  number  of  deaths  occurring  amongst  strangers  be 
not  excessive,  they  may  fairly  be  included  in  calculating 
the  death-rate,  because  in  this  case  they  may  be  con- 
sidered as  fairly  representing  the  deaths  of  those  persons 
belonging  to  the  district  who  have  died  elsewhere. 

So  far,  then,  the  problem  of  calculating  the  annual 
death-rate  of  any  town  or  district  becomes  a  very  easy 
matter  when  the  statistics  are  summarised  for  a  whole 
year.  But  in  respect  to  some  large  towns  it  is  customary 
for  the  health  officer  to  publish  weekly,  monthly,  or  quar- 
terly reports,  and  as  all  the  rates  given  in  these  reports 
are  calculated  as  annual  rates  per  1000  of  the  population 
living  in  the  middle  of  the  year,  the  problem  becomes  con- 
siderably more  complicated.  When  monthly  reports  are 
submitted  some  medical  officers  of  health  calculate  the 
annual  rates  by  taking  five  weeks  for  the  months  of  March, 
June,  September,  and  December,  and  four  for  the  other 
months ;  but  this  method,  though  convenient,  is  not  strictly 
accurate,  and  it  is  much  preferable  to  adopt  the  method 
pursued  by  the  Eegistrar-General.  This  is  so  fully  and 
clearly  described  in  an  article  which  appeared  in  the 
Sanitary  Record  of  August  1875,  that  it  may  be  fitly 
quoted  here : — 

"  In  the  first  place  it  is  scarcely  necessary  to  say  that  all  the 
rates  now  published  by  the  Eegistrar-General,  whether  they  relate 
to  a  year,  a  month,  or  a  week,  are  annual  rates  to  1000  persons 
living  ;  that  is,  these  published  rates  represent  the  number  of  per- 
sons who  would  die  in  the  year  in  1000  of  each  population,  if  the 
proportion  of  deaths  to  population  recorded  in  the  shorter  periods  of 
a  week,  or  a  month,  or  a  quarter,  were  maintained  throughout  a 
whole  year. 

"  Let  us  take  a  rate  of  mortality  from  the  Registrar-General's 
last  weekly  return  relating  to  the  seven  days  ending  July  31  as  an 
example.  We  find  in  Tables  1  and  2  of  that  return  it  is  stated 
that  the  estimated  population  of  the  borough  of  Sheffield  in  the 
middle  of  1875  is  267,881  persons  ;  that  127  deaths  were  recorded 
within  the  borough  during  the  week  under  notice  ;  and  further,  that 


VITAL  STATISTICS.  409 

these  deaths  were  equal  to  an  annual  rate  of  24*7  per  1000  of  this 
estimated  population.  Now  for  the  operation  by  which  this  result 
is  arrived  at.  "We  have  the  deaths  in  a  week,  and  the  estimated 
population  in  which  they  occurred  ;  it  is  desired  to  find  the  number 
of  the  deaths  which  would  occur  in  each  1000  of  this  population, 
if  the  same  number  of  deaths  were  recorded  in  each  week  through- 
out a  year.  If  a  week  were  the  correct  fifty-second  part  of  a  year, 
it  is  obvious  that  either  the  deaths  must  be  multiplied  by  fifty-two 
or  the  population  be  divided  by  fifty-two,  in  order  to  make  the 
population  and  the  deaths  comparable.  As,  however,  the  correct 
number  of  days  in  a  natural  year  is  365*24226,  the  number  of 
weeks  in  a  year  is  52*17747.  The  Registrar  -  General,  therefore, 
for  the  purpose  of  this  weekly  return,  divides  the  estimated  popula- 
tion of  each  of  the  towns  dealt  with  by  52*17747,  which  gives 
what  may  be  called  the  weekly  population  of  each  town.  The 
population  of  Sheffield  divided  by  52*17747  gives  a  weekly  popu- 
lation of  5134  persons  ;  this  number  serves  as  constant  throughout 
the  year  1875,  by  which  to  divide  the  number  of  deaths.  The 
127  deaths  in  Sheffield  during  the  week  ending  July  31,  divided 
by  this  so-called  weekly  population,  gives  an  annual  rate  of  0*0247 
to  each  person  of  the  population  ;  and  by  removing  the  decimal 
point  three  places  to  the  right,  or  in  other  words  multiplying  by 
1000,  we  arrive  at  24*7,  which  is  the  correct  annual  rate  of  mor- 
tality per  1000  of  the  estimated  population  of  the  borough  of  Shef- 
field during  that  week.  It  would  undoubtedly  be  more  logical  to 
multiply  the  deaths  by  52*17747  than  to  deal  with  the  population  * 
but  this  operation  would  have  to  be  repeated  each  week,  whereas 
there  is  a  manifest  convenience,  and  an  arithmetical  economy,  in 
the  reverse  operation  (the  effect  of  which  is,  of  course,  identical),  which 
supplies  us  with  a  constant  that  is  applicable  throughout  the  fifty-two 
weeks  of  1875.  For  all  practical  purposes  the  multiplication  of 
the  deaths  in  a  week  by  fifty-two,  in  order  to  divide  them  by  the  esti- 
mated population,  will  afford  the  means  of  arriving  at  an  approxi- 
mately correct'  annual  rate  of  mortality  ;  or  the  reverse  operation, 
the  division  of  the  population  by  fifty-two,  may  be  resorted  to. 

"  For  the  calculation  of  annual  rates  of  mortality  in  a  month  or 
a  quarter  the  Registrar-General  takes  account  of  the  number  of  days 
in  each  month  or  quarter,  and  it  is  found  more  convenient  to  deal 
with  the  population  according  to  the  method  described  in  the  cal- 
culation of  the  annual  rate  of  mortality  in  a  week.  The  populations 
to  be  dealt  with  are  divided  by  365*24226,  and  must  then  be  mul- 
tiplied by  the  number  of  days  in  a  month  or  a  quarter,  in  order  to 
arrive  at  the  population  which  may  be  applied  to  the  deaths  in  a 
month  or  a  quarter  ;  by  this  means  a  scientifically  correct  annual 


410 


VITAL  STATISTICS. 


death-rate  in  those  respective  periods  will  be  obtained.  Approxi- 
mately correct  annual  rates  of  mortality  in  a  month  or  a  quarter 
may  be  calculated  by  using  a  twelfth  or  a  quarter  of  the  population 
respectively,  as  the  divisor  of  the  number  of  deaths  recorded  in  those 
periods ;  but,  inasmuch  as  the  length  of  a  month  varies  from 
twenty-eight  to  thirty-one  days,  and  of  a  quarter,  from  ninety  to 
ninety-two  days,  it  is  evident  that  a  correct  annual  rate  of  mortality 
can  only  be  calculated  by  taking  into  account  this  variation  in  the 
number  of  days  in  those  periods,  and  that  rates  calculated  without 
correction  for  these  inequalities  will  differ  from  the  rates  published 
by  the  Kegistrar-General. 

"  In  conclusion,  it  may  be  noted  that  rates  published  in  the 
quarterly. returns  of  the  Kegistrar-General  for  the  eighteen  largest 
English  towns  relate  to  the  period  of  thirteen  weeks  most  nearly 
corresponding  with  the  natural  quarter,  and  that  the  population 
employed  in  this  calculation  is  thirteen  times  that  used  for  the  rates 
in  each  week,  and  differs  slightly  from  the  population  that  would 
be  used  if  the  period  of  observation  were  three  entire  calendar 
months  instead  of  thirteen  weeks.  The  facts  published  in  the  quar- 
terly return  for  all  other  parts  of  the  country,  except  the  eighteen 
largest  English  towns,  relate  to  the  natural  quarters  of  three  calen- 
dar months,  and  the  population  used  to  produce  the  annual  rates  of 
mortality  therein,  are  manipulated  in  the  manner  before  described." 

The  following  table  is  interesting  as  showing  the  gradual 
and  progressive  decline  in  the  death-rates  of  both  urban 
and  rural  districts  throughout  England  and  Wales,  and 
how  greatly  the  urban  have  been  gaining  on  the  rural 
districts  as  regards  healthiness  : — 

URBAN  AND  KURAL  DEATH-KATES  AT  SUCCESSIVE 
PERIODS. 


MEAN  ANNUAL  DEATH-RATES  PER  1000  LIVING. 

YEARS. 

Urban  Districts. 

Rural  Districts. 

Rural  Rate  below 
Urban  Rate. 

In  4  years  1847-50 

26-9 

20-6 

23  '4  per  cent. 

In  10  years  1851-60 

247 

19-9 

19-4       „ 

In  10  years  1861-70 

24-8 

197 

20-6 

In  10  years  1871-80 

231 

19-0 

177       „ 

In  the  year  1880 

21-9 

18-5 

15-5       „ 

VITAL  STATISTICS.  411 

In  1880,  the  general  death-rate  for  England  and 
Wales  was  20'5  per  1000,  while  the  mean  death-rate  of 
1881  and  1882  was  only  19/3  per  1000,  being  2'1 
below  the  mean  rate  of  the  preceding  ten  years  18*71-80. 
As  regards  sex,  the  male  death-rate  in  1880  was  21*8, 
and  the  female  death-rate  19*3  per  1000,  while  out  of 
equal  numbers  living  of  each  sex,  there  died  in  the  course 
of  the  year  1131  males  to  1000  females. 

In  addition  to  the  birth-rate  and  death-rate,  the  other 
rates  which  are  generally  given  in  the  reports  of  medical 
officers  of  health  are  the  death-rate  from  zymotic  disease 
and  the  rate  of  infant  mortality. 

(2).  Zymotic  Death-Rate. — What  is  called  the  death- 
rate  from  the  seven  principal  zymotic  diseases,  or  zymotic 
death-rate,  is  based  on  the  total  number  of  deaths  occur- 
ring  in  a  district  during  the  year  due  to  smallpox,  measles, 
scarlatina,  diphtheria,  whooping-cough,  fever  (typhus, 
typhoid,  and  other  or  doubtful  forms  of  continued  fever), 
and  diarrhoea.  This,  like  the  birth-rate  or  total  annual 
death-rate,  is  calculated  on  the  estimated  population  of  the 
district,  and  is  expressed  as  so  many  per  1000.  Thus, 
we  will  suppose  that  in  an  estimated  population  of  22,438 
the  deaths  from  the  seven  principal  zymotic  diseases 
amounted  to  48  during  the  year;  the  zymotic  death-rate 
in  this  instance  would  be  : — 

48 x 1000 
22,438    =2'1  per  1000. 

According  to  the  returns  of  the  Eegistrar-General,  the 
mean  annual  death-rate  from  the  seven  principal  zymotic 
diseases  in  England  and  Wales  in  the  three  decades 
1851-60,  1861-70,  and  1871-80,  was  3'87,  411,  and 
3*36  per  1000  respectively,  while  during  the  two  years 
1881-82  it  had  fallen  to  2 -44. 

The  annual  death-rate  from  any  other  group  of  dis- 


412  VITAL  STATISTICS. 

eases,  or  from  any  single  disease  such  as  fever  or  phthisis, 
is  calculated  in  the  same  way  as  the  zymotic  death-rate. 
Thus,  the  number  of  deaths  attributed  to  "  fever"  which 
occurred  in  England  and  Wales  during  1882  amounted 
to  7971,  and  as  the  estimated  population  at  the  middle 
of  the  year  was  26,406,820,  the  death-rate  from  fever 
was  — 


In  the  three  most  recent  decades  it  was  equal  to  0*91, 
0-89,  and  0*49  per  1000  respectively,  thus  showing  a 
most  marked  decline. 

(3.)  Hate  of  Infant  Mortality.  —  The  rate  of  infant 
mortality,  in  the  returns  of  the  Registrar-  General  and  in 
most  health  reports,  is  measured  by  the  proportion  of 
deaths  of  infants  under  one  year  to  births  registered,  and 
is  expressed  as  so  many  per  1000  births.  Thus,  we  will 
suppose  that  the  total  number  of  deaths  of  children  under 
one  year  of  age  which  occurred  in  a  given  district 
amounted  to  112  during  the  year,  and  that  the  births 
registered  during  the  year  amounted  to  898,  the  rate 
of  infant  mortality  estimated  in  this  way  will  there- 
fore be  — 

898  :  1000  :  :  112  :  X, 

__       112x1000 
°rX= 


The  annual  rate  of  infant  mortality  in  England  and 
Wales  for  1882  was  equal  to  141  per  1000  registered 
births,  while  the  average  rate  for  the  ten  years  1870-79 
was  150  per  1000. 

(4.)  Death  -Bate  at  various  groups  of  Ages.  —  The 
death-rate  of  children  under  five  years  of  age  is  sometimes 
expressed  as  a  percentage  of  the  total  number  of  deaths,  or 


VITAL  STATISTICS. 


413 


it  may  be  expressed  as  a  rate  per  1000  of  the  estimated 
number  of  children  under  five  years  living  in  the  middle 
of  the  year.  This  estimate,  like  that  of  the  population 
of  a  district,  is  calculated  on  the  total  number  of  children 
living  under  five  years,  as  actually  enumerated  at  the  two 
last  censuses,  and  published  in  the  census  reports.  In 
the  same  way,  the  death-rate  among  persons  of  any  given 
age  is  calculated  from  the  estimated  population  living  at 
that  age,  or  the  mortality  per  1000  persons  living  may  be 
stated  according  to  groups  of  ages.  This  is  shown  in  the 
following  table  from  the  Eegistrar- General's  Eeport  for 
1880:— 


ANNUAL  KATE  OF  MORTALITY  PER  1000  PERSONS  LIVING 
AT  TWELVE  GROUPS  OF  AGES  DURING  1880. 


REGISTRATION 
COUNTIES. 

ALL 
AGES. 

0— 

5- 

10— 

15— 

20— 

25— 

35- 

45— 

55— 

65— 

75— 

85  and 
up- 
wards. 

ENGLAND. 

Average    Annual  ) 
Ratt  in  25  Years  > 
184S-7U         .        .  J 

22-4 

67-9 

8-3 

4-8 

6-7 

8'8 

9-9 

127 

17-0 

301 

62-0 

139-6 

294-2 

ENGLAND   .       . 

20-5 

64-4 

6-3 

3-3 

4-8 

6-1 

77 

11-5 

16'0 

30'4 

61-2 

131  '3 

257-9 

It  is  thus  seen  that  the  rate  of  mortality  declines  as 
age  advances  from  birth  to  puberty,  and  then  increases 
somewhat  slowly  to  between  50  and  60.  From  the  age 
55  to  the  end,  the  mortality  increases  at  such  a  rate  as 
to  be  doubled  every  ten  years.  The  table  also  shows  that, 
comparing  the  rates  of  1880  with  the  average  annual 
rates  (1848-72),  there  has  been  a  marked  lowering  of  the 
death-rates  at  all  the  groups  of  ages  except  that  of  55-56. 

(5.)  Death-Rate  of  Persons  engaged  in  various  Occu- 
pations.— According  to  Dr.  Farr,  "  the  only  way  in 
which  the  mortality  and  the  duration  of  life  of  miners, 


414  VITAL  STATISTICS. 

tailors,  farmers,  labourers,  or  any  other  class  of  men, 
can  be  accurately  determined  is  to  determine  the  ratio 
of  deaths  at  each  age  to  the  living  during  a  certain 
time — in  fact,  to  apply  the  same  method  to  each  class 
as  is  applied  to  determine  the  mortality  and  the  mean 
lifetime  of  all  classes  in  a  town,  in  a  district,  or  in  the 
whole  kingdom."  The  Supplements  to  the  Twenty-fifth 
and  Thirty-fifth  Eeports  of  the  Kegistrar-General  contain 
a  vast  amount  of  statistical  information  bearing  upon  this 
important  subject,  showing  to  what  extent  the  nature  of 
the  occupation  influences  mortality. 

(6.)  Death-Hates  in  Different  Localities. — The  general 
death-rate  of  the  population  is  an  average  of  high  and 
low  death-rates.  High  death-rates  prevail  in  large  towns 
and  low  death-rates  in  country  districts,  while  in  large 
towns  it  is  found  that  the  death-rate  varies  enormously 
in  different  parts.  According  to  Dr.  Farr,  the  mortality 
of  districts  increases  with  the  density  of  their  population ; 
but  density  of  population  is  a  complex  condition,lmplying  a 
combination  of  many  separate  morbific  agencies,  social  and 
sanitary,  which  can  only  be  ascertained  by  analysing  and 
comparing  statistical  results,  and  especially  with  regard  to 
age-distribution.  Thus,  the  fashionable  suburbs  of  large 
towns  inhabited  by  the  wealthy  classes  always  contain  a 
great  excess  of  adults  of  the  ages  in  which  low  death- 
rates  prevail,  while  the  birth-rate  is  also  low.  In  the 
poorer  and  more  crowded  localities,  on  the  other  hand, 
there  are  no  servants  kept,  and  the  birth-rate  is  high,  so 
that  the  much  higher  mortality  among  infants  and  young 
children,  compared  with  that  of  the  adult  population, 
raises  the  death-rate  of  the  population  to  which  they 
belong.  But  even  when  due  allowance  is  made  for  age- 
distribution,  it  is  found  that  the  mortality  in  all  the 
crowded  parts  of  large  towns  is  much  higher  at  nearly  all 
ages,  and  especially  during  childhood,  adolescence,  and 


VITAL  STATISTICS. 


415 


the  productive  period  of  life,  than  in  the  better  circum- 
stanced and  more  salubrious  suburbs. 

(7.)  Mortality  in  relation  to  Seasons. — In  estimating 
the  significance  of  statistical  results,  no  correct  inferences 
can  be  drawn  unless  due  attention  is  paid  to  the  important 
influence  of  weather  changes.  Generally  speaking,  it  may 
be  said  that  during  winter  there  is  a  predisposition  to 
diseases  of  the  respiratory  organs,  and  that  any  fall  below 
the  mean  average  temperature  is  followed  by  an  increased 
sick -rate  and  death-rate  from  these  diseases.  During 
summer,  on  the  other  hand,  intestinal  disorders  become 
more  prevalent,  and  any  rise  above  the  mean  average 
temperature  will  be  followed  by  an  increased  sick -rate 
and  death-rate  from  diarrhoea  and  filth  diseases  generally. 
As  a  rule,  the  mortality  is  highest  in  the  first  quarter  of 
the  year  and  lowest  in  the  third, — the  order  from  highest 
to  lowest  being  first,  fourth,  second,  third, — but  in  many 
districts  this  sequence  is  found  to  vary  considerably,  and, 
indeed,  it  is  found  to  vary  in  respect  to  the  country 
generally,  as  the  following  table  will  show : — 


YEARS. 

ANNUAL  DEATH-KATES  PER  1000  LIVING 
in  the  Quarter  ending  the  last  day  of 

March. 

June. 

September. 

December. 

1870-79      .... 
1880      

241 
227 

21'1 
19-6 

19-8 
20-3 

21'6 
19-5 

4.  Longevity. — This  term  may  be  used  to  embrace 
various  statistical  expressions,  to  which  brief  reference 
may  be  made,  such  as — 

(1.)  Mean  Age  at  Death. — The  mean  age  at  death  of 
the  population  is  obtained  by  dividing  the  sum  total  of 
the  ages  at  death  by  the  number  of  deaths.  It  is  a  very 


416  VITAL  STATISTICS. 

fallacious  indication  of  longevity,  and  affords  no  true  test 
of  sanitary  condition,  because  it  fluctuates  very  largely, 
according  to  the  varying  proportions  of  young  and  old 
lives  in  different  districts.     In  districts  where  the  birth- 
rate is  high  the  mean  age  at  death  will  be  comparatively 
low.     The  mean  age  at  death  of  an  entire  generation 
alone  gives  accurately  the  mean  duration  of  life,  and  this 
is  determined   by  life -tables.     According   to  Dr.  Farr's 
life-table,  which  was  based  upon  the  census  and  mortality 
returns  1838-54*,  the  mean  age  at  death  of  an  English 
generation  was  40'86  years.     But  inasmuch  as  the  popu- 
lation of  England  is  not  stationary,  but  always  rapidly 
increasing,  by  reason  of  the  excess  of  births  over  deaths, 
the  mean  age  at  death  of  all  who  died  during  the  years 
1838-54  was  29'4  instead  of  4O86.     These  averages 
have  recently  been  supplemented  by  Mr.  Humphreys,  in 
a  most  valuable  paper  read  before  the  Statistical  Society 
of  London  (see  Sanitary  Record,  May  and  June   1883), 
in  which  he  discusses  the  whole  bearings  of  improved 
sanitation,  as   evidenced   by   the   recent   decline   in   the 
English  death-rate,  and  its  effect  upon  the  duration  of 
life.     According  to  Mr.  Humphreys'  new  life-table,  based 
upon  the  last  census  returns  and  the  mortality  returns 
of    1876-80,   the    mean    age    at    death   of    an   English 
generation  is  raised  to  4 3 '5  6  years,  while  the  mean  age 
at  death  of  persons  dying  in  the  five  years  1876-80  was 
found  to  be  about  3  2  years.     In  respect  to  sex,  the  mean 
age  at  death  of  males,  according  to  Dr.  Farr's  life-table, 
was    39*91    years,  and   of   females  41*85   years,  while 
according  to  Mr.  Humphreys'  new  life-table,  the  former 
has  risen  to  41*92  years,  equal  to  an  addition  of  5  per 
cent  to  the  mean  duration  of  the  lifetime  of  males,  and 
the  latter  to  45*25  years,  representing  an  addition  of  over 
8  per  cent  to  the  average  lifetime  of  all  females  born. 
It  may  here  be  explained  that  in  constructing  these 


VITAL  STATISTICS. 


417 


life-tables,  the  calculations  are  based  on  a  hypothetical 
generation  of  a  million  persons,  consisting  of  the  same  pro- 
portion of  males  and  females  at  birth  and  at  subsequent 
ages,  which  is  found  to  exist  in  the  general  population, 
and  on  the  numbers  of  each  sex  dying  each  succeeding 
year,  until  the  whole  generation  becomes  extinct. 

(2.)  Expectation  of  Life  or  mean  after  -  lifetime  at 
various  ages. — The  expectation  of  life,  calculated  for 
years  or  groups  of  ages,  represents  the  portion  of  future 
life  which  an  individual  at  any  age  may  reasonably  ex- 
pect to  enjoy ;  and  this,  like  the  mean  age  at  death  or 
mean  duration  of  life,  is  given  in  life-tables.  Such  tables 
afford  the  best  means  of  testing  the  vitality  of  com- 
munities. The  following  life- table,  given  by  Mr.  Hum- 
phreys in  the  paper  already  referred  to,  not  only  shows 
clearly  how  the  recent  decline  in  the  English  death-rate  has 
affected  the  mean  duration  of  life  in  this  country,  but  how 
it  has  affected  the  mean  after-lifetime  at  various  ages : — 

Mean  After-Lifetime  (Expectation  of  Life  at  various  Ages),  from 
Life-Tables  based  upon  English  Mortality  in  1838-54  and, 
1876-80. 


Ages. 

Persons. 

Males. 

Females. 

1838-54. 

1876-80. 

1838-54. 

1876-80. 

1838-54. 

1876-80. 

0    

5 
10 
15 
20 
25 
35 

40-86 

50-02 
47-36 
43-54 
39-88 
36-57 
29-99 
23-41 
16-94 
11-17 
6-72 
3-87 

43-56 

52-56 
49-24 
45-05 
40-98 
37-21 
30-01 
23-29 
1675 
11-19 
6-81 
4-00 

39-91 

4971 
47-05 
43-18 
39-48 
36-12 
29-40 
22-76 
16-45 
10-82 
6-49 
373 

41-92 

51-47 
48-16 
43-94 
39-86 
36-05 
28-88 
22-34 
16-09 
10-79 
6-52 
3-78 

41-85 

50-33 
47-67 
43-90 
40-29 
37-04 
30-59 
24-06 
17-43 
11-51 
6-93 
3-98 

45-25 

53-65 
50-32 
46-15 
42-10 
38-36 
31-12 
24-21 
17-37 
11-55 
7-04 
4-15 

45 
55 
65 
75   

85  and  upwards 

2   E 


418  VITAL  STATISTICS. 

From  this  table  it  will  be  seen  that  the  expectation  of 
life  has  been  increased  at  all  groups  of  ages  up  to  twenty- 
five  among  males,  and  up  to  fifty-five  among  females. 
But  Mr.  Humphreys,  by  a  further  analysis  of  the  more 
extended  life-tables,  also  shows  that  as  much  as  66  per 
cent  of  the  increased  duration  of  human  life  in  England 
is  lived  at  what  is  called  the  useful  and  productive  period, 
namely,  between  20  and  60  years,  and  not  more  than 
34  per  cent  at  the  dependent  periods  either  of  childhood 
(0-20),  or  of  old  age  (60  and  upwards).  These  figures 
are  very  reassuring,  and  sufficiently  refute  the  pessimist 
assertions  which  have  recently  been  advanced  with  refer- 
ence to  the  reduced  death-rate,  that  sanitary  improve- 
ments have  only  resulted  in  an  increase  t  in  the  passive 
endurance  of  life  rather  than  in  an  increase  of  true 
vitality  and  genuine  usefulness. 

(5.)  Morbidity. — This  term  has  recently  been  intro- 
duced to  denote  the  amount  of  illness  existing  in  a  given 
community,  and  is  intended  to  express  the  sick-rate  just 
as  the  term  mortality  expresses  the  death-rate. 

In  the  absence  of  any  complete  system  of  registration 
of  cases  of  %  disease,  and  taking  into  consideration  the  fact 
that  disease  often  sets  in  so  insidiously  and  is  frequently 
so  ill-defined,  it  becomes  a  matter  of  considerable  difficulty 
to  estimate  the  amount  of  sickness  which  may  be  pre- 
valent in  any  district  during  any  stated  period.  Hitherto 
such  estimates  have  been  based  mainly  on  the  records  of 
sick-clubs,  benefit  societies,  army,  navy,  and  police,  and 
they  apply  solely  to  disabling  sickness  occurring  amongst 
lives  which  may  be  regarded  as  selected.  From  such 
records  of  sick-time,  Dr.  Farr,  in  his  supplement  to  the 
Thirty-fifth  Eeport  of  the  Kegistrar-General,  has  estimated 
that  to  one  annual  death  in  a  body  of  men  two  men  are 
on  an  average  constantly  suffering  from  sickness  of  some 
severity,  or  in  other  words,  that  to  every  death  there  are 


VITAL  STATISTICS.  419 

two  years  of  severe  sickness.  In  the  police  and  some 
friendly  societies,  the  constantly  sick  to  every  death  that 
occurs  are  2*8,  while  in  the  army  at  home  the  ratio  is 
4 '2,  the  difference  being  due  to  the  prevalence  of  enthetic 
disease. 

With  regard  to  diseases  which,  as  a  rule,  occur  only 
once  during  a  lifetime,  such  as  scarlatina,  smallpox,  and 
some  of  the  other  zymotic  diseases,  an  approximate  estimate 
of  the  number  of  cases  occurring  in  a  district  can  some- 
times be  made  from  the  number  of  deaths.  Thus  the  ^ 
mortality  occurring  among  cases  of  scarlatina  admitted 
into  hospitals  has  been  taken  as  a  basis  for  calculating 
the  number  of  cases  in  any  district  from  the  deaths 
registered  in  such  district,  and  the  ratio  estimated  in  this 
way  has  been  given  as  about  ten  cases  for  every  death. 
But  such  estimates  are  comparatively  valueless,  because, 
apart  from  the  incompleteness  of  the  data  on  which  they 
are  based,  the  mortality  will  vary  very  much  according 
to  the  severity  of  the  epidemic.  Far  more  reliable 
statistics  will  doubtless  be  obtained  after  an  extended 
experience  of  the  registration  of  cases  of  infectious  disease 
in  those  towns  in  which  powers  for  compulsory  noti- 
fication have  been  obtained. 

Concluding  Remarks. — In  drawing  conclusions  from 
statistical  data,  it  need  hardly  be  said  that  great  care 
must  be  taken  to  guard  against  fallacies.  For  example, 
the  death-rate  of  a  district  may  be  comparatively  low  by 
reason  of  the  preponderance  of  adult  or  selected  lives, 
while  the  sanitary  conditions  are  by  no  means  satisfactory; 
or  again,  the  total  death-rate  may  not  be  above  the 
average,  while  the  death-rate  in  certain  portions  of  the 
district  may  be  excessively  high.  Generally  speaking, 
the  effects  of  sanitary  improvements  and  precautionary 
measures  are  best  indicated  by  a  lowered  death-rate  from 
infectious  diseases,  fever,  diarrhoea,  and  phthisis,  and 


420  VITAL  STATISTICS. 

amongst  children  under  five  years  from  all  causes. 
Indeed,  it  may  be  said  that  the  death-rate  of  children 
under  five  years  of  age  is  in  many  localities  a  far  more 
reliable  criterion  of  the  sanitary  conditions  affecting  the 
health  of  communities  than  the  total  annual  death-ratet 
even  although  every  allowance  is  made  for  neglect,  de- 
ficiency of  food,  mal-nutrition,  and  exposure.  Nor,  again, 
in  drawing  inferences  from  mortality  returns,  must  the 
influence  of  social  causes  of  disease  be  forgotten-,  for  the 
effects  of  intemperance,  immorality,  and  early  or  in- 
judicious marriages,  especially  amongst  the  lower  classes 
in  all  our  large  towns,  can  scarcely  be  over-estimated. 
(For  further  details  see  succeeding  chapter  and  Appendix.) 


DUTIES  UF  MEDICAL  OFFICERS  OF  HEALTH.  421 


CHAPTEK    XVI. 

THE  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

BY  clauses  189  and  190  of  the  Public  Health  Act  1875, 
it  is  enacted  that  it  shall  be  the  duty  of  every  urban  and 
of  every  rural  sanitary  authority,  throughout  England  and 
Wales,  to  appoint  from  time  to  time  a  legally -qualified 
medical  officer  or  officers  of  health  for  the  efficient  execu- 
tion of  the  purposes  of  the  Sanitary  Acts.  In  the  case  of 
rural  sanitary  districts,  such  officers  may  be  the  district 
medical  officers  of  unions,  who  are  to  a  certain  extent 
under  the  control  of  the  Local  Government  Board ;  but 
in  the  case  of  urban  sanitary  districts,  those  medical 
officers  of  health  are  alone  subject  to  the  control  of  the 
Local  Government  Board  whose  salaries  are  partly  paid 
out  of  moneys  voted  by  Parliament.  Such  sanitary  autho- 
rities, therefore,  as  do  not  choose  to  receive  assistance 
from  the  public  purse  in  the  payment  of  their  health- 
officers,  may  appoint  or  dismiss  such  officers  without  the 
consent  of  the  Local  Government  Board,  and  may  issue 
such  regulations  for  their  guidance  as  they  may  from  time  - 
to  time  determine.  In  either  case,  however,  the  duties 
of  the  medical  officer  of  health  will,  in  great  measure,  be 
identical  as  regards  the  main  points ;  and  hence  the  fol- 
lowing regulations,  whicli  have  been  issued  by  the  Local 
Government  Board  for  the  guidance  of  medical  officers  of 
health  whose  appointments  are  made  subject  to  the 
approval  of  the  Board,  may  be  considered  as  more  or  less 


422  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

applicable  to  all  health  officers.  By  an  order,  dated  llth 
November  1872,  which  is  still  in  force,  these  duties  are 
thus  denned : — 

"  The  following  shall  be  the  duties  of  the  medical  officer  of 
health  in  respect  of  the  district  for  which  he  is  appointed  ;  or,  if 
he  shall  be  appointed  for  more  than  one  district,  then  in  respect  of 
each  of  such  districts  : — 

"  1.  He  shall  inform  himself,  as  far  as  practicable,  respecting 
all  influences  affecting  or  threatening  to  affect  injuriously  the  public 
health  within  the  district. 

"  2.  He  shall  inquire  into  and  ascertain  by  such  means  as  are 
at  his  disposal  the  causes,  origin,  and  distribution  of  diseases  within 
the  district,  and  ascertain  to  what  extent  the  same  have  depended 
on  conditions  capable  of  removal  or  mitigation. 

"3.  He  shall,  by  inspection  of  the  district,  both  systematically 
at  certain  periods,  and  at  intervals  as  occasion  may  require,  keep 
himself  informed  of  the  conditions  injurious  to  health  existing 
therein. 

"  4.  He  shall  be  prepared  to  advise  the  sanitary  authority  on 
all  matters  affecting  the  health  of  the  district,  and  on  all  sanitary 
points  involved  in  the  action  of  the  sanitary  authority  or  authori- 
ties ;  and  in  cases  requiring  it,  he  .shall  certify,  for  the  guidance 
of  the  sanitary  authority  or  of  the  justices,  as  to  any  matter  in 
respect  of  which  the  certificate  of  a  medical  officer  of  health  or  a 
medical  practitioner  is  required  as  the  basis  or  in  aid  of  sanitary 
action. 

"  5.  He  shall  advise  the  sanitary  authority  on  any  question 
relating  to  health  involved  in  the  framing  and  subsequent  working 
of  such  bye-laws  and  regulations  as  they  may  have  power  to  make. 

"6.  On  receiving  information  of  the  outbreak  of  any  contagious, 
infectious,  or  epidemic  disease  of  a  dangerous  character  within  the 
district,  he  shall  visit  the  spot  without  delay  and  inquire  into  the 
causes  and  circumstances  of  such  outbreak,  and  advise  the  persons 
competent  to  act  as  to  the  measures  which  may  appear  to  him  to 
be  required  to  prevent  the  extension  of  the  disease,  and,  so  far  as 
he  may  be  lawfully  authorised,  assist  in  the  execution  of  the  same. 

•"  7.  On  receiving  information  from  the  inspector  of  nuisances, 
that  his  intervention  is  required  in  consequence  of  the  existence  of 
any  nuisance  injurious  to  health,  or  of  any  overcrowding  in  a  house, 
he  shall,  as  early  as  practicable,  take  such  steps  authorised  by  the 
statutes  in  that  behalf  as  the  circumstances  of  the  case  may  justify 
and  require. 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  423 

"  8.  In  any  case  in  which  it  may  appear  to  him  to  be  necessary 
or  advisable,  or  in  which  he  shall  be  so  directed  by  the  sanitary 
authority,  he  shall  himself  inspect  and  examine  any  animal,  carcase, 
meat,  poultry,  game,  flesh,  fish,  fruit,  vegetables,  corn,  bread,  or 
flour,  exposed  for  sale,  or  deposited  for  the  purpose  of  sale,  or  of 
preparation  for  sale,  and  intended  for  the  food  of  man,  which  is 
deemed  to  be  diseased,  or  unsound,  or  unwholesome,  or  unfit  for  the 
food  of  man  ;  and  if  he  find  that  such  animal  or  article  is  diseased, 
or  unsound,  or  unwholesome,  or  unfit  for  the  food  of  man,  he  shall 
give  such  directions  as  may  be  necessary  for  causing  the  same  to  be 
seized,  taken,  and  carried  away,  in  order  to  be  dealt  with  by  a  justice 
according  to  the  provisions  of  the  statutes  applicable  to  the  case. 

"  9.  He  shall  perform  all  the  duties  imposed  upon  him  by  any 
bye-laws  and  regulations  of  the  sanitary  authority  duly  confirmed, 
in  respect  of  any  matter  affecting  the  public  health,  and  touching 
which  they  are  authorised  to  frame  bye-laws  and  regulations. 

"10.  He  shall  inquire  into  any  offensive  process  of  trade  carried 
on  within  the  district,  and  report  on  the  appropriate  means  for  the 
prevention  of  any  nuisance  or  injury  to  health  therefrom. 

"11.  He  shall  attend  at  the  office  of  the  sanitary  authority  or 
at  some  other  appointed  place,  at  such  stated  times  as  they  may 
direct. 

"12.  He  shall  from  time  to  time  report,  in  writing,  to  the 
sanitary  authority,  his  proceedings  and  the  measures  which  may 
require  to  be  adopted  for  the  improvement  or  protection  of  the 
public  health  in  the  district.  He  shall  in  like  manner  report  with 
ivspect  to  the  sickness  and  mortality  within  the  district,  so  far  as  he 
lias  been  enabled  to  ascertain  the  same. 

"  13.  He  shall  keep  a  book  or  books,  to  be  provided  by  the 
Military  authority,  in  which  he  shall  make  an  entry  of  his  visits, 
ami  notes  of  his  observations,  and  instructions  thereon,  and  also  the 
date  and  nature  of  applications  made  to  him,  the  date  and  result  of 
the  action  taken  thereon,  and  of  any  action  taken  on  previous 
reports,  and  shall  produce  such  book  or  books,  whenever  required, 
to  the  sanitary  authority. 

"  14.  He  shall  also  prepare  an  annual  report  to  be  made  at  the 
t'lid  of  December  in  each  year,  comprising  tabular  statements  of  the 
sickness  and  mortality  within  the  district,  classified  according  to 
diseases,  ages,  and  localities,  and  a  summary  of  the  action  taken 
during  the  year  for  the  preventing  the  spread  of  disease.  The  report 
shall  also  contain  an  account  of  the  proceedings  in  which  he  has 
taken  part  or  advised  under  the  Sanitary  Acts,  so  far  as  such  pro- 
ceedings relate  to  conditions  dangerous  or  injurious  to  health,  and 
ul.-M>  on  account  of  the  supervision  exercised  by  him,  or  on  lii.s 


424  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

advice,  for  sanitary  purposes,  over  places  and  houses  that  the 
sanitary  authority  has  power  to  regulate,  with  the  nature  and  results 
of  any  proceedings  which  may  have  been  so  required  and  taken  in 
respect  of  the  same  during  the  year.  It  shall  also  record  the  action 
taken  by  him,  or  on  his  advice,  during  the  year,  in  regard  to 
offensive  trades,  bakehouses,  and  workshops. 

."15.  He  shall  give  immediate  information  to  the  Local  Govern- 
ment Board  of  any  outbreak  of  dangerous  epidemic  disease  within 
the  district,  and  shall  transmit  to  the  Board,  on  forms  to  be  provided 
by  them,  a  quarterly  return  of  the  sickness  and  deaths  within  the 
district,  and  also  a  copy  of  each  annual  and  of  any  special  report. 
;  •  "  16.  In  matters  not  specifically  provided  for  in  this  order,  he 
shall  observe  and  execute  the  instructions  of  the  Local  Government 
Board  on  the  duties  of  Medical  Officers  of  health,  and  all  the  lawful 
orders  and  directions  of  the  sanitary  authority  applicable  to  his  office. 
"17.  Whenever  the  Diseases  Prevention  Act  of  1855  is  in 
force  within  the  district,  he  shall  observe  the  directions  and  regula- 
tions issued  under  that  Act  by  the  Local  Government  Board,  so  far 
as  the  same  relate  to  or  concern  his  office." 

For  the  efficient  and  conscientious  discharge  of  these 
duties,  it  is  evident  that  a  medical  officer  of  health  must 
make  himself  thoroughly  acquainted  with  the  fundamental 
principles  of  public  and  practical  hygiene,  with  the  general 
and  local  circumstances  which  may  affect  the  health  of 
the  population  in  his  district,  and  with  the  various  clauses 
of  the  Public  Health  and  other  Acts  which  more  immedi- 
ately concern  his  office.  So  much  is  left  to  his  discre- 
tionary power  in  advising  the  sanitary  authority,  and  in 
certifying  as  to  what  is  or  is  not  injurious  to  the  public 
health,  that  he  cannot  but  feel  the  grave  responsibility 
which  will  devolve  upon  him,  if  through  ignorance  or 
neglect  on  the  one  hand,  or  through  mistaken  zeal  and 
want  of  tact  on  the  other,  he  fails  to  carry  out  his  duties 
honestly,  judiciously,  and  efficiently. 

As  there  is  no  doubt  that  considerable  difficulty  will 
be  experienced  at  the  outset  by  most  health  officers  in 
regard  to  the  mode  in  which  their  duties  should  be  carried 
out,  the  various  suggestions  and  practical  details  summa-r- 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  425 

ised  under  the  following  sections,  may,  it  is  hoped,  prove 
as  serviceable  as  they  are  reliable : — 

SECTION  I.  —  NATURAL  CONDITIONS  AFFECTING  THE 
HEALTH  OF  THE  POPULATION  CONTAINED  IN  THE 
DISTRICT. 

These  comprise  the  geological  and  topographical 
characteristics  of  the  district,  the  water-supply,  and  the 
climate. 

1.  Geological  Conditions. — Official  information  as  re- 
gards these  may  be  obtained  from  the  Ordnance  maps  and 
the  special  sections  published  by  the  Survey  or- General ; 
while  fuller  details  could  be  readily  collected  from  local 
sources.     In  most  districts  there  will  generally  be  found 
some  one  who  has  made  the  geology  of  the  locality  a 
special  study. 

2.  Topographical    Conditions. — These    relate   to  the 
situation  of  the  various  parts  of  the  town   or  district, 
whether  low-lying,  elevated,  or  sloping.     * 

3.  Water -Supply. — The  quantity  and  quality  of  the 
obtainable  water-supply  in  a  district  will  depend  very 
much  on  the  two  previous  sets  of  conditions.     So  also 
will  the  nature  of  the  subsoil  and  the  facilities  for  drain- 
age  and   sewerage.      All  this,  however,  has   been   fully 
explained  in  previous  parts  of  this  work. — (See  Chapters 
VI.,  VIIL,  and  XIII.) 

Speaking  generally,  the  diseases  which  are  found  to 
be  most  largely  associated  with  natural  conditions  in  this 
country  are  phthisis,  and  probably  also  other  lung  diseases, 
ague,  cancer,  rheumatism,  heart  disease,  diphtheria,  and 
goitre.  In  this  field  of  inquiry,  Mr.  Haviland's  writings 
on  the  geographical  distribution  of  disease  will  be  found 
to  be  very  serviceable. 

4.  Climate. — Under  this  heading  are  comprised  the 


426  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

meteorological  conditions  of  the  district,  such  as  the  daily 
temperature  and  rainfall,  the  force  and  direction  of  winds, 
the  barometric  pressure,  the  degree  of  humidity,  and  the 
amount  of  ozone.  In  most  large  towns  these  observations 
are  already  being  carefully  recorded,  and  where  this  is  the 
case,  the  health  officer  should  endeavour  to  obtain,  through 
the  sanitary  authority,  the  record  of  the  observations 
weekly.  In  districts  where  no  such  observations  are  made, 
it  will  be  no  part  of  his  duty  to  supply  this  information, 
but  at  the  same  time  it  is  necessary  that  he  should  take 
cognisance  of  meteorological  fluctuations,  because  they  con- 
stitute very  important  factors  of  health  or  disease  in  every 
district. 


SECTION  -II.  —  ARTIFICIAL  CONDITIONS  AFFECTING  THE 
HEALTH  OF  THE  POPULATION  CONTAINED  IN  THE 
DISTRICT;  such  as — 

1.  Habitations  of  the  People. — So  far  as  possible  the 
sanitary  condition  of  every  house  in  the  district  should  be 
inquired  into.  Of  course  the  health  officer  himself  could 
not  undertake  such  a  laborious  inquiry,  but  in  towns  it 
could  be  easily  and  efficiently  carried  out  by  the  temporary 
appointment  of  one  or  more  competent  persons,  who  would 
be  paid  by  the  sanitary  authority  and  directed  by  the 
health  officer;  while  in  small  urban  or  rural  districts  it 
can  be  carried  out  by  the  sanitary  inspector. 

In  carrying  out  a  systematic  inquiry  of  this  descrip- 
tion in  rural  districts,  it  is  advisable  that  the  inspector 
should  complete  the  survey  of  one  or  more  parishes  or 
villages  before  submitting  the  details  to  the  medical  officer 
of  health,  who  would  then  appoint  a  day  for  going  over 
the  survey  with  the  inspector.  During  the  inspection  he 
should  satisfy  himself  as  to  the  accuracy  of  the  returns, 
advise  with  regard  to  particular  defects,  and  in  this  way 


DUTIES  OF  MEDICAL  OFFICEKS  OF  HEALTH.  427 

make  himself  fully  acquainted  with  the  sanitary  condition 
of  every  part  of  his  district  in  detail.  The  tabulated 
forms  to  be  used  for  such  a  survey,  when  it  is  authorised 
by  the  sanitary  authority,  will  vary  slightly,  according  as 
the  district  is  urban  or  rural.  Those  devised  by  Dr.  Bond 
of  Gloucester,  although  somewhat  bulky,  will  be  found  to 
be  well  arranged  and  admirably  suited  for  rural  districts. 
They  contain  the  following  headings  in  the  several 
columns  : — Number ;  No.  of  case  in  nuisance  book ;  date 
of  inspection ;  situation  and  description  of  premises ; 
names  of  occupier  and  owner ;  number  of  living  rooms, 
sleeping  rooms,  and  inmates ;  nature,  situation,  and  con- 
dition of  closet-accommodation ;  nature  of  water-supply ; 
defects  in  drainage,  ventilation,  or  general  condition  of 
premises ;  existence  of  any  special  source  of  actual  or 
possible  nuisance ;  remarks  by  medical  officer  of  health ; 
additional  observations.  With  very  rare  exceptions,  the 
inspector  will  meet  with  no  opposition  in  carrying  out 
the  survey,  nor  the  medical  officer  of  health  in  obtaining 
any  information  with  regard  to  any  points  which  he  may 
consider  desirable.  Further  particulars  with  regard  to  the 
sanitary  condition  of  premises,  overcrowding,  nuisances 
generally,  and  how  to  draw  up  reports,  will  be  given  in 
Section  IV.  (See  also  Chapter  IX.) 

2.  Water -Supply. — In  districts  where  the  water- 
supply  is  public,  the  medical  officer  of  health  should  make 
himself  acquainted  with  the  quality  of  the  water,  amount 
per  head,  and  the  risks  of  pollution,  both  as  regards  the 
source  of  supply  and  the  mode  of  distribution.  The 
nature  of  the  supply,  whether  constant  or  intermittent, 
the  relation  between  mains  and  closets  ;  the  situation  and 
condition  of  cisterns  ;  the  separation  of  cisterns  for  domes- 
tic supply  from  those  supplying  closets ;  the  situation  of 
overflow  pipes,  and  the  like,  are  all  points  which  should 
receive  careful  attention.  In  rural  districts,  the  sufficiency 


428  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

of  the  water-supply,  as  well  as  its  quality,  the  situation 
of  wells,  and  the  risks  of  pollution,  should  all  be  duly 
noted,  and  samples  of  suspicious  well-water  should  be 
examined.  In  villages  where  the  water-supply  is  in- 
sufficient, it  will  become  a  question  for  the  medical  officer 
of  health  to  advise  generally  as  to  how  this  want  may  best 
be  remedied,  whether  by  providing  one  or  more  public 
wells,  by  introducing  a  public  supply,  by  compelling 
neighbouring  owners  of  property  to  unite  in  providing  a 
sufficient  supply  under  the  new  Public  Health  (Water) 
Act,  by  storage  of  the  rainfall,  or  by  carting  water  into 
the  village  to  meet  special  emergencies,  leaving  of  course 
all  practical  details  to  be  dealt  with  by  the  sanitary  en- 
gineer or  inspector.  (Chapters  VI.  and  VII.) 

3.  Drainage,  Sewerage,  Scavenging,  etc. — In  towns  full 
information  with  regard  to  these  conditions  will  be  ob- 
tained   from    the   borough   engineer   or    town    surveyor. 
Special  attention  should  be  given  to  the  ventilation  and 
flushing  of  sewers,  and  the  condition  of  house-drains  as 
regards  ventilation,  flushing,  freedom  from  smell,  and  con- 
struction;  while   the  ventilation   of  water-closets,   soil- 
pipes,  and,  as  far  as  possible,  the  severance  of  all  direct 
communication  of  house-drains  with  sewers,  are  additional 
points   of  importance  which   should   not   escape   notice. 
The  efficiency  of  the  scavenging  arrangements  should  also 
be  carefully  inquired  into.     In  country  districts  it  will 
devolve  upon  the  medical  officer  of  health  to  report  as  to 
whether  the  drainage  of  particular  villages  is  satisfactory, 
and  to  recommend  or  not,  as  he  may  think  fit,  as  to 
whether  a  competent  engineer  should  be  called  in  to  sur- 
vey and  prepare  plans.     In  certain  cases,  too,  he  will 
have  to  inquire  and  decide  as  to  whether  public  scavenging 
has  not  become  necessary  to  ensure  adequate  local  cleanli-  ' 
ness.      (See  Chapters  XL,  XII.,  and  XIII.) 

4.  Factories,    Workshops,  Bakehouses,  Public   Institu- 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  429 

tions,  Slaughter -houses,  etc. — These  should  be  examined 
with  reference  to  overcrowding,  air-impurities,  and  the 
production  of  nuisances  generally.  (See  Chapter  III.  and 
Section  IV.  of  the  present  chapter.)  Tactories  already 
under  Government  inspection  would  not  of  course  be  sub- 
ject to  the  supervision  of  the  health  officer,  except  in  so 
far  as  they  prove  to  be  a  nuisance  or  injurious  to  the 
health  of  the  neighbouring  inhabitants.  In  country  dis- 
tricts special  attention  should  be  given  to  the  sanitary 
condition  of  village-schools,  whether  public  or  private,  and 
also  to  the  sanitary  condition  of  graveyards. 

'SECTION  III. — VITAL  STATISTICS. 

In  addition  to  obtaining  a  full  knowledge  of  the 
natural  and  artificial  conditions  which  affect  the  health 
of  the  population,  the  medical  officer  of  health  should  also 
make  himself  acquainted  with  the  vital  statistics  of  his 
district.  By  referring  to  the  more  recent  Quarterly  and 
Annual  Eeports  of  the  Eegistrar-General,  the  books  of  the 
district-registrar,  the  abstracts  of  the  Boards  of  Guardians, 
and  any  reports  which  have  already  appeared  with  regard 
to  the  health  of  the  district,  he  will  obtain  all  the  statistical 
data  representing  its  vital  history  for  the  past  few  years, 
as  indicated  by  the  number  of  the  population,  its  rate  of 
increase,  the  birth-rate,  the  marriage -rate,  the  rate  of 
mortality,  the  prevalency  of  epidemic  or  other  specially 
fatal  diseases,  the  death-rate  at  different  ages,  the  amount 
of  pauperism,  etc.  From  the  last  census  returns,  again, 
he  will  obtain  much  useful  information  as  regards  the 
areas,  houses,  and  population,  and  the  ages,  civil  condition, 
and  occupation  of  the  people. 

Amongst  other  works  which  will  be  found  very  ser- 
viceable, are  the  Digest  of  the  English  Census  of  1871, 
by  Mr.  Lewis,  and  the  Supplement  to  the  Thirty-fifth 


430  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

Annual  Eeport  of  the  Kegistrar- General,  published  in 
1875.  This  supplement  contains  Dr.  Farr's  Eeport  on 
the  Mortality  of  the  Eegistration  Districts  of  England 
during  the  years  1861-1870,  a  report  which  is  full  of 
information  of  the  most  varied  kind,  and  exhibits  in  the 
most  masterly  way  the  wide  range  of  logical  deductions 
that  can  be  based  on  vital  statistics  when  properly  tabu- 
lated and  accurately  arranged. 

Such  a  retrospect,  it  need  hardly  be  said,  would  form 
a  sound  basis  of  local  statistical  knowledge  to  start  with, 
and  by  pursuing  the  same  course  with  regard  to  the 
registration  and  pauper  returns,  which  should  be  obtained 
regularly,  the  medical  officer  of  health  will  be  in  a  position 
at  all  times  to  inform  the  sanitary  authority  concerning 
the  prevalence  of  infectious  and  preventable  diseases,  and 
advise  as  to  what  steps  should  be  taken.  But  as  the 
death-rate  gives  no  sufficient  indication  of  the  sick-rate, 
he  should  also  obtain  the  pauper  sick  returns  immediately 
after  each  meeting  of  the  guardians,  and  as  far  as  possible 
the  returns  from  the  public  medical  institutions  in  his 
district.  Arrangements  should  likewise  be  made  through 
the  sanitary  authority,  that  poor-law  medical  officers 
should  report  without  delay  the  occurrence  of  any  case  of 
fever  or  infectious  disease,  and  that  the  district-registrar 
should  at  once  forward  a  return  of  any  death  from  such 
disease.  Further,  if  the  medical  officer  of  health  is  pre- 
cluded from  practice,  he  will  generally  find  that  the 
medical  practitioners  in  his  district  will  give  him  much 
timely  information,  provided  he  is  careful  not  to  make 
himself  too  officious ;  but  until  the  registration  of  cases 
of  infectious  disease  is  rendered  compulsory,  the  only 
returns  which  are  provided  for  in  the  instructions  of  the 
Local  Government  Board  are  the  returns  of  the  district- 
registrar,  the  pauper  sick  returns,  and  such  returns  with 
regard  to  infectious  disease  which  the  sanitary  inspector 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  431 

can  obtain.  Arrangements  may,  however,  be  made  with 
local  practitioners  to  report  all  cases  of  certain  specified 
dangerous  infectious  diseases  on  payment  of  a  fixed  fee 
per  case  by  the  sanitary  authority. 

The  district -registrars  throughout  the  country  are 
instructed  by  the  Kegistrar-General  to  forward  the  returns 
of  births  and  deaths  to  the  medical  officer  of  health,  and 
are  allowed  2d.  per  entry  for  remuneration,  which  the 
sanitary  authority  is  empowered  by  the  Local  Government 
to  pay.  The  sanitary  authority  also  supplies  the  blank 
forms,  and  defrays  the  expense  of  postage.  Except  as 
regards  deaths  from  fever  or  other  infectious  disease,  a 
return  of  which  should  be  forwarded  immediately,  the 
usual  returns  of  the  registrar  should  be  forwarded  to  the 
medical  officer  of  health  at  the  close  of  every  week. 
Blank  forms  may  be  obtained  from  Messrs.  Knight  and 
Co.,  publishers,  Fleet  Street,  London ;  Messrs.  Shaw  and 
Sons,  Fetter  Lane,  London ;  or  Messrs.  Farrant  and  Frost, 
Merthyr-Tydfil.  (See  Appendix.) 

By  means  of  the  information  supplied  by  these  weekly 
returns,  the  medical  officer  of  health  is  enabled  to  tabulate 
the  mortality  statistics  in  such  a  manner  as  will  show  the 
birth-rate,  the  total  death-rate,  the  death-rate  at  different 
ages,  the  death-rate  from  zymotic  disease,  the  connection 
between  the  total  infantile  or  zymotic  death-rate,  and  the 
sanitary  or  insanitary  condition  of  various  parts  of  his 
district,  the  prevalency  of  any  particular  diseases  in  cer- 
tain areas,  and  so  on.  If  the  district  is  a  large  urban 
one,  the  diseases  may  be  classified  according  to  sub-dis- 
tricts or  streets,  and  if  it  be  a  large  rural  one,  they  may 
be  classified  according  to  sub-districts  or  parishes.  In 
large  urban  districts  the  classification  should  be  that  used 
by  the  Eegistrar-General,  or  the  system  recommended  by 
the  Society  of  Medical  Officers  of  Health.  (See  Appendix.) 
In  small  urban  or  rural  districts,  however,  it  is  by  no 


432  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

means  necessary  to  compile  elaborate  tables,  and  the 
classification  which  is  given  in  the  quarterly  returns  to  the 
Local  Government  Board,  or  some  similar  classification,  will 
answer  all  practical  purposes.  For  the  sake  of  comparison 
it  is  much  to  be  regretted  that  some  uniform  system  of 
classification  is  not  enforced  in  all  districts,  a  simple  sys- 
tem for  rural  and  small  urban  districts,  and  a  more 
elaborate  system  for  urban  districts  containing  say  25,000 
inhabitants  and  upwards.  In  combined  districts  too,  there 
is  some  chance  of  confusion  arising  from  the  fact  that  the 
registration  sub-districts  are  frequently  not  conterminous 
with  the  several  sanitary  districts,  inasmuch  as  small  urban 
districts  generally  form  part  of  a  registration  sub-district, 
the  other  part  being  included  in  a  neighbouring  rural 
sanitary  district. 

What  is  required  of  the  medical  officer  of  health  is 
that  he  should  classify  his  returns  honestly  and  with  no 
preconceived  ideas  as  to  what  the  figures  are  to  prove ; 
and  although  mistakes  may  sometimes  be  made  in  dia- 
gnosis, he  is  bound  to  classify  the  returns  as  he  receives 
them,  unless  after  due  inquiry  he  is  convinced  that  in 
exceptional  cases  such  mistakes  have  been  made.  Even 
then  it  is  essential,  as  a  statist,  that  he  should  present  the 
returns  as  they  are  sent  in  to  him ;  and  if  he  has  reason 
to  question  their  accuracy,  he  should  honestly  state  his 
reasons,  after .  as  far  as  possible  consulting  with  the 
medical  attendant.  This  of  course  is  always  a  delicate 
matter,  requiring  the  utmost  tact  and  conscientiousness, 
because  under  any  circumstances  it  is  an  interference 
liable  to  be  resented,  and  especially  if  the  medical  officer 
of  health  is  not  precluded  from  practice.  But,  whether 
the  medical  officer  of  health  is  in  practice  or  not,  enough 
has  been  said  in  the  preceding  chapter  to  show  not  only 
the  necessity  of  constant  and  systematic  attention  on  his 
part  to  the  vital  statistics  of  his  district,  but  also  the 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  433 

immense  assistance  which  a  logical  use  of  them  will 
afford  him  in  estimating  rightly  the  separate  or  com- 
bined influences  of  avoidable  or  removable  causes  of 
disease.  (See  Chapter  XV.) 

SECTION  IV. — DUTIES  REQUIRED  OF  THE  MEDICAL  OFFICER 
OF  HEALTH  FOR  THE  EFFICIENT  EXECUTION  OF  THE 
SANITARY  ACTS. 

As  the  health  officer  must  "be  prepared  to  advise 
the  sanitary  authority  on  all  points  involved  in  the 
action  of  the  sanitary  authority  or  authorities,"  it  is 
necessary  that  he  should  make  himself  acquainted  with 
the  Public  Health  Act  of  1875,  and  the  other  Acts  or 
portions  of  them  which  more  immediately  concern  his 
office.  Previous  to  the  consolidation  of  the  various 
Sanitary  Acts  in  the  Public  Health  Act  of  1875,  the 
task  of  wading  through  these  numerous  enactments,  so  as 
to  obtain  a  practical  knowledge  of  the  clauses  affecting 
the  duties  of  the  health  officer,  was  by  no  means  an  easy 
one.  All  this,  however,  is  now  very  much  simplified,  and 
the  only  Acts  which  the  health  officer  need  consult,  may 
be  confined,  with  a  few  exceptions,  to  the  Public  Health 
Act,  1875,  the  Artisans'  Dwellings  Act,  1875,  the  Canal 
Boats  Act,  1877,  and  the  Public  Health  (Water)  Act, 
1878.  And  here  it  may  be  observed  that  though  the 
Public  Health  Act  permits  the  medical  officer  of  health 
to  exercise  any  of  the  powers  with  which  an  inspector  of 
nuisances  is  invested,  it  is  not  his  duty  to  search  for 
nuisances.  By  all  means  let  him  make  an  inspection 
whenever  he  deems  it  necessary,  or  when  he  has  reason 
to  believe  that  the  sanitary  inspector  is  not  properly 
attending  to  his  duty,  but  he  should  avoid  as  far  as  pos- 
sible interfering  with  matters  which  in  the  first  instance 
concern  the  office  of  the  surveyor  or  sanitary  inspector. 

2  F 


434  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

He  should,  nevertheless,  be  fully  qualified  to  advise  and 
give  suggestions,  and  in  order  to  do  so  it  is  essential  that 
he  should  be  well  acquainted  with  practical  details.  The 
clauses  in  the  Public  Health  Act,  to  which  special  atten- 
tion should  be  directed,  are  classed  in  order  as  they 
appear  in  the  list,  under  the  following  headings : — 

1.  Sewerage  and  Drainage  (clauses  13-26). — The  two 
most  important  clauses  in  this  section,  so  far  as  the 
medical  officer  of  health  is  concerned,  are  clause  19, 
which  makes  it  incumbent  on  every  local  authority  to 
have  all  sewers  constructed,  ventilated,  and  kept,  so  that 
they  shall  not  be  a  nuisance  ;  and  clause  23,  which  em- 
powers local  authorities  to  enforce  the  drainage  of  un- 
drained  houses,  such  drainage  to  be  carried  out  in  all 
particulars  to  the  satisfaction  of  the  surveyor.  (See 
Chapter  XL) 

.  2.  Privies,  Water-closets,  etc.  (clauses  35-41). — These 
clauses  give  full  powers  to  sanitary  authorities  to  enforce 
closet  accommodation,  and  to  provide  that  all  drains, 
water-closets,  earth-closets,  privies,  ashpits,  and  cesspools, 
within  their  district,  be  constructed  and  kept  so  as  not  to 
be  a  nuisance  or  injurious  to  health.  With  regard  to 
structural  details,  and  especially  the  alterations  which  are 
required  to  remedy  the  defects  which  are  so  commonly 
connected  with  the  closet  accommodation  of  rural  districts, 
see  Chapter  XL 

3.  Scavenging  and  Cleansing  (clauses  42-47). — By 
virtue  of  these  clauses,  sanitary  authorities  are  empowered, 
or  they  may  be  required  by  order  of  the  Local  Govern- 
ment Board,  to  provide  for  the  cleansing  of  streets  and 
the  removal  of  refuse ;  and  in  localities  where  the  scaveng- 
ing is  undertaken  by  the  sanitary  authority,  any  occupier 
of  premises  may  claim  a  penalty  not  exceeding  five  shil- 
lings a  day  from  the  local  authority  if  they  neglect,  after 
due  notice,  to  cleanse  any  earth- closet,  privy,  ashpit,  or 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.'  435 

cesspool,  belonging  to  such  premises.  In  all  cases,  there- 
fore, where  the  medical  officer  of  health  is  convinced  that 
public  scavenging  has  become  necessary,  he  ought  to  urge 
that  this  duty  be  undertaken  by  the  sanitary  authority, 
and  if  they  refuse  to  comply  with  his  request,  he  should 
have  no  hesitation  in  appealing  to  the  Local  Government 
Board  to  issue  the  necessary  order.  In  places  where 
there  is  no  public  scavenging,  the  local  authority  may 
make  by-laws  imposing  the  duty  of  cleansing  footways 
and  pavements  adjoining  premises,  and  of  removing  all 
offensive  refuse  from  the  premises,  on  the  occupier. 
Clause  46  gives  power  to  order  the  cleansing  and  purify- 
ing of  houses  on  the  certificate  of  the  medical  officer  of 
health;  and  clause  47  imposes  penalties  in  respect  to 
certain  nuisances  occurring  on  premises  in  urban  districts. 
(See  Chapter  XI.) 

4.  Offensive  Ditches  and  Collections  of  Matter  (clauses 
48-50). — These  clauses  provide  for  the  obtaining  of  orders 
for  cleansing  offensive  ditches  lying  near  to  or  forming 
the  boundaries  of  districts ;  for  the  removal  of  filth-accu- 
mulations on  the  certificate  of  the  sanitary  inspector ;  and 
for  the  periodical  removal  of  manure  from  mews  and  other 
premises  in  urban  districts. 

5.  Water-Supply  (clauses  51-70). — These  clauses  re- 
late to  the  general  powers  of  sanitary  authorities  for  sup- 
plying their  districts  with  water,  whether  by  waterworks 
or  wells  ;  to  provisions  for  the  protection  of  water-supplies 
against  pollution ;  and  to  the  closing,  cleansing,  or  repair- 
ing of  polluted  wells.     (See  Chapters  VI.  and  VII.) 

In  the  Public  Health  (Water)  Act,  1878,  power  is 
given  to  enforce  a  wholesome  supply  for  isolated  houses 
or  groups  of  houses  if  within  a  certain  limit  of  outlay;  and 
it  is  further  enacted  that  no  house  which  has  been  newly 
built  or  rebuilt  shall  be  occupied  unless  such  wholesome 
supply  is  first  provided.  The  Act  applies  specially  to 


436  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

rural  districts,  and  if  systematically  carried  out  will  be  of 
immense  service  in  improving  the  health  of  these  districts. 

6.  Regulation  of  Cellar  Dwellings  and  Lodging- Houses 
(clauses  71-90). — Besides  prohibiting  the  occupation  of 
.cellars  absolutely,  or  only  under  certain  conditions,  these 
clauses  provide  for  the  registration  of  common  lodging- 
houses,  and  the  issuing  of  by-laws  for  their  regulation, 
and  they  also  empower  the  Local  Government  Board  to 
authorise  the  local  authority  to  make  by-laws  in  respect 
to  houses  other  than  common  lodging-houses  which  are 
let  in  lodgings,  or  occupied  by  members  of  more  than  one 
family.     As  regards  watering-places,  and  other  fashion- 
able health-resorts,  this  last  provision  is  one  of  great  im- 
portance, inasmuch  as  it  would  not  only  ensure  the  removal 
of  any  sanitary  defects  from  houses  let  in  lodgings,  but 
it  also  renders  it  compulsory  on  lodging-house  keepers  to 
give  immediate  notice  to  the  sanitary  authority  in  cases  of 
infectious  disease,  and  to  take  proper  precautions. 

7.  Nuisances  (clauses  91-111). — As  this  section  of 
the  Public  Health  Act  is  a  very  important  one,  it  may  be 
considered  more  fully  in  detail.     The  several  classes  of 
nuisances  are  defined  by  the  Act  as  follows : — 

(1.)  "  Any  premises  in  such  a  state  as  to  be  a  nuis- 
ance or  injurious  to  health." 

It  need  hardly  be  said  that  this  definition,  by  reason 
of  its  vagueness,  includes  a  great  variety  of  sanitary 
defects,  and,  like  the  other  definitions,  implies  injury  to 
health,  whether  probable  or  actual,  as  a  consequence  of 
the  nuisance.  Unfortunately,  too,  this  vagueness  is;  if 
possible,"  still  further  increased  by  the  definition  in  the 
preamble  of  the  Act,  which  states  that  "  lands  and  premises 
include  messuages,  buildings,  lands,  easements,  and  heredi- 
taments, of  any  tenure."  All  this  gives  ample  room  for 
legal  quibbles,  but,  so  far  as  the  duties  of  the  medical 
officer  of  health  and  the  sanitary  inspector  are  concerned, 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  437 

there  is  usually  little  difficulty  experienced  in  carrying 
out  the  intention  of  the  Act.  The  sanitary  defects  im- 
plied in  the  definition  have  reference,  for  the  most  part, 
to  the  cleansing  or  whitewashing  of  dirty  houses ;  the 
repair  of  roofs  that  let  in  the  rain ;  the  repair  of  walls 
and  uneven  floors ;  the  opening  of  fastened  windows  to 
improve  the  ventilation ;  the  repair  of  closets ;  the  relay- 
ing of  defective  drains ;  the  ventilation,  trapping,  or 
disconnection  of  house-drains ;  the  removal  of  privies  or 
pig-styes  abutting  against  outside  walls;  the  prevention 
of  dampness  as  far  as  possible  ;  the  repair  of  yards,  and, 
especially  in  rural  districts,  the  sanitary  improvement  of 
farm-yards  adjoining  the  dwelling-houses.  When  it  is 
not  possible  to  put  a  house  into  habitable  repair,  or  when 
the  necessary  repairs  are  not  carried  out  in  compliance 
with  the  notice  issued  by  the  sanitary  inspector,  power 
is  given,  by  clause  97,  to  close  the  house  by  order  of 
a  Justice.  With  regard  to  the  difficulties  of  dealing 
with  the  question  of  defective  house-accommodation,  see 
Chapter  IX. 

(2.)  "Any  pool,  ditch,  gutter,  water -course,  privy, 
urinal,  cesspool,  drain,  or  ashpit,  so  foul,  or  in  such  a 
state  as  to  be  a  nuisance,  or  injurious  to  health." 

This  definition  requires  no  further  comment  than 
this,  that  whenever  any  offensive  smell  is  given  off  by 
any  pool,  ditch,  etc.,  whether  it  be  in  the  proximity  of 
dwellings,  or  near  any  frequented  road  or  footpath,  there 
is  sufficient  evidence  of  the  existence  of  a  nuisance  which 
calls  for  removal.  All  foul  privies,  cesspools,  and  drains 
in  rural  districts  can  be  dealt  with  under  this  clause. 

(3.)  "Any  animal  so  kept  as  to  be  a  nuisance  or 
injurious  to  health." 

This  definition  applies  to  pig-styes,  fowl-pens,  dog- 
kennels,  cow-byres,  etc.  In  dealing  with  nuisances  of 
this  description,  it  often  happens  that  the  abatement  may 


438  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

be  effected  in  various  ways.  For  example,  a  nuisance 
arising  from  a  pig-stye  may  be  abated  sometimes  by  keep- 
ing the  animal  in  a  more  cleanly  way,  by  lessening  the 
number  of  pigs,  by  properly  draining  the  pig-stye,  by 
removing  the  pig-stye  if  it  be  too  near  a  dwelling,  or  too 
near  a  frequented  path,  or  by  prohibiting  the  keeping  of 
pigs  altogether.  It  may  safely  be  laid  down  as  a  rule, 
that  pig-styes  close  to  dwellings,  or  under  bedroom  win- 
dows, will  always  be  more  or  less  a  nuisance,  no  matter 
how  carefully  the  animal  may  be  kept. 

(4.)  "  Any  accumulation  or  deposit  which  is  a  nuis- 
ance or  injurious  to  health." 

In  this  definition  are  included  offensive  manure-heaps, 
or  other  filth-accumulations,  which  are  close  to  dwellings 
or  frequented  paths.  It  also  applies  to  offensive  refuse- 
heaps  of  every  description, — the  only  exception  being 
made  "  in  respect  of  any  accumulation  or  deposit  neces- 
sary for  the  effectual  carrying  on  any  business  or  manu- 
facture, if  it  be  proved  to  the  satisfaction  of  the  Court 
that  the  accumulation  or  deposit  has  not  been  kept  longer 
than  is  necessary  for  the  purposes  of  the  business  or  manu- 
facture, and  that  the  best  available  means  have  been  taken 
for  preventing  injury  thereby  to  the  public  health." 

(5.)  "  Any  house  or  part  of  a  house  so  overcrowded 
as  to  be  dangerous  or  injurious  to  the  health  of  the  in- 
mates, whether  or  not  members  of  the  same  family." 

In  previous  parts  of  this  work  the  necessity  for  an 
ample  amount  of  cubic  space  for  the  requirements  of  per- 
fect health  has  been  strongly  insisted  on — an  amount, 
however,  which  it  is  impossible  to  obtain  or  enforce  in 
the  dwellings  of  the  poorer  classes,  and  in  common  lodg- 
ing houses.  Practically  it  is  found  that  300  cubic  feet 
per  head  is  the  highest  minimum  which  can  be  enforced 
in  most  large  towns,  and  even  that  amount  cannot  be 
exacted  in  the  case  of  many  families  consisting  of  husband 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  439 

and  wife  and  young  children.  In  rural  districts  also  the 
difficulty  of  dealing  with  this  form  of  nuisance  on  reason- 
able and  equitable  grounds  is  quite  as  great  as  it  is  in 
towns,  if  not  greater ;  and  as  an  instance  in  point,  I  may 
quote  the  following  remarks  from  one  of  my  reports  for 
1874  : — "In  places  where  there  is  a  scarcity  of  houses, 
it  is  evidently  impossible  to  abate  the  nuisance  to  any 
extent,  because  in  attempting  to  reduce  the  overcrowding 
in  one  part  you  only  increase  it  elsewhere.  But  in  Mid- 
Warwickshire  this  difficulty  has  not  arisen,  partly  because 
the  district  is  mainly  agricultural  and  can  only  maintain 
a  limited  number  of  the  labouring  class,  and  partly,  too, 
I  have  no  doubt,  because  during  the  last  two  or  three 
years  there  has  been  a  considerable  exodus  from  a  good 
many  of  the  villages  in  consequence  of  the  agricultural 
labourers'  movement.  The  cases  of  overcrowding  met 
with  have  been  generally  confined  to  single  families 
occupying  houses  with  only  one  sleeping  -  room,  and  in 
endeavouring  to  deal  with  this  form  of  nuisance  there 
were  several  points  which  had  to  be  considered.  In  the 
first  place,  it  was  clear  that  if  the  minimum  allowance  of 
cubical  space  per  head  was  made  too  high,  the  instances 
of  overcrowding,  judged  by  this  standard,  would  have 
become  so  numerous  that  any  attempt  to  deal  with  them 
woidd  have  been  impossible ;  in  the  second  place,  the 
ages  of  the  children  had  to  be  taken  into  account ;  and 
in  the  third  place,  it  became  a  question  whether  in  con- 
demning a  house  as  being  too  small  for  the  family,  another 
and  suitable  one  was  to  be  found  in  the  village.  With 
regard  to  cubical  space,  it  appeared  to  me,  after  careful 
inquiry  into  the  average  amount  of  sleeping  accommoda- 
tion, that  the  standard  of  200  cubic  feet  per  head  was  as 
high  as  it  could  be  raised  for  families  consisting  of  parents 
and  young  children,  though  at  the  same  time  I  am  free  to 
confess  that  a  minimum  of  300  cubic  feet  space,  even 


440  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

with  good  means  of  ventilation,  is  little  enough  for  the 
requirements  of  health.  But  in  cases  where  it  was  found 
that  grown-up  children  of  both  sexes  slept  in  the  same 
room,  or  in  the  same  room  with  their  parents,  the  ques- 
tion of  cubic  space  became  a  matter  of  secondary  con- 
sideration, and  the  plea  of  overcrowding  has  been  insisted 
on  in  the  interests  of  decency  as  much  as  on  the  score  of 
health.  It  will  thus  be  seen  that  the  cases  of  overcrowd- 
ing met  with  had  to  be  decided  according  to  the  special 
circumstances  of  each  rather  than  in  accordance  with  any 
fixed  rules,  and  though  the  minimum  cubic  space  which 
has  been  adopted  is  small,  it  must  be  borne  in  mind  that 
the  dilapidated  state  of  most  of  the  cottages  permits  a 
freer  interchange  of  air  than  is  usually  to  be  obtained  in 
newer  and  better  built  houses.  All  this  is,  of  course,  an 
admission  that  only  the  more  glaring  cases  of  overcrowd- 
ing have  been  dealt  with ;  but  with  so  many  cottages 
containing  only  one  sleeping-room,  and  taking  into  con- 
sideration the  size  of  the  rooms,  it  is  impossible  to  lessen 
the  extent  of  the  evil  except  by  acting  on  principles  such 
as  these.  As  it  is,  many  cases  of  overcrowding  have 
been  abated,  and  the  notices  issued  by  the  Inspectors 
have  been  so  generally  complied  with  that  only  a  few 
cases  had  to  be  brought  before  the  magistrates." 

(6.)  "Any  factory,  workshop,  or  workplace  (not 
already  undei  the  operation  of  any  general  Act  for  the 
regulation  of  factories  or  bakehouses),  not  kept  in  a 
cleanly  state,  or  not  ventilated  in  such  a  manner  as  to 
render  harmless,  as  far  as  practicable,  any  gases,  vapours, 
dust,  or  other  impurities  generated  in  the  course  of  the 
work  carried  on  therein,  that  are  a  nuisance  or  injurious 
to  health,  or  so  overcrowded  while  work  is  carried  on  as 
to  be  dangerous  or  injurious  to  the  health  of  those  em- 
ployed therein."  (See  Chapter  III.) 

(7.)  "  Any  fireplace  or  furnace  which  does  not,  so  far 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  441 

as  practicable,  consume  the  smoke  arising  from  the  com- 
bustible consumed  therein,  and  which  is  used  for  work- 
ing engines  by  steam,  or  in  any  mill,  factory,  dyehouse, 
brewery,  bakehouse,  or  gaswork,  or  in  any  manufacturing 
or  trade  process  whatsoever ;  and  any  chimney  (not  being 
the  chimney  of  a  private  dwelling-house)  sending  forth 
black  smoke  in  such  quantity  as  to  be  a  nuisance,  shall 
be  deemed  to  be  nuisances  liable  to  be  dealt  with  sum- 
marily in  manner  provided  by  this  Act ;"  provided  always 
that  it  can  be  shown  that  the  best  practical  means  have 
been  adopted  to  consume  the  smoke,  having  regard  to  the 
manufacture  or  trade,  and  that  due  care  has  been  exer- 
cised by  the  person  in  charge  of  the  same. 

In  order  to  obviate  nuisances  of  this  description,  all 
furnaces  or  factory  fireplaces  should  have  chimneys  of 
sufficient  height,  and  should  be  provided  with  a  smoke- 
consuming  apparatus.  Very  often  it  is  found  that  nuis- 
ance ^arises  from  neglect  in  stoking. 

8.  0/ensive  Trades  (clauses  112-115). — By  these 
clauses  power  is  given  to  urban  sanitary  authorities  to 
restrict  the  establishment  of  offensive  trades  in  their  dis- 
tricts, such  as  bone-boiling,  soap-boiling,  tallow-melting, 
etc. ;  to  make  by-laws  with  respect  to  the  same  ;  and  to 
direct  complaint  to  be  made  before  a  Justice,  if  the  effluvia 
given  off  are  certified  to  be  a  nuisance  or  injurious  to 
health,  by  the  medical  officer  of  health,  or  by  two  legally- 
qualified  practitioners,  or  by  any  ten  inhabitants  of  the 
district.  Before  a  conviction  can  be  obtained  in  respect 
to  established  trades,  it  will  be  necessary  to  prove  to  the 
satisfaction  of  the  Court  that  the  best  practical  means  for 
the  abatement  of  the  nuisance  have  not  been  adopted  ; 
and  as  the  medical  officer  of  health  is  liable,  in  most  cases, 
to  be  called  upon  to  give  skilled  evidence,  it  is  necessary 
that  he  should  be  well  acquainted  with  the  process  of 
manufacture,  or  the  details  of  the  trade  complained  of,  the 


442  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

nature  of  the  effluvia  given  off,  and  the  best  means  which 
should  be  adopted  to  prevent  nuisance.  Such  knowledge 
can,  of  course,  only  be  obtained  by  inspecting  offensive 
trades,  and  it  must  necessarily  be  supplemented  by  a 
thorough  acquaintance  with  practical  chemistry.  Unless 
the  medical  officer  of  health  is  an  expert  in  these  matters, 
the  best  course  to  .pursue  is  to  recommend  the  manufac- 
turer or  tradesman,  against  whom  complaint  is  made,  to 
call  in  some  competent  person  to  advise  him  as  to  what 
steps  he  should  take  to  prevent  nuisance ;  and  in  the 
event  of  no  steps  being  taken,  he  should  recommend  the 
sanitary  authority  to  consult  an  expert,  who  would  give 
evidence  before  the  magistrates  if  necessary. 

With  proper  precautions,  the  manufacturer  of  offensive 
products  may,  in  the  greater  majority  of  instances,  carry 
on  his  trade  without  causing  serious  nuisance  to  the 
neighbourhood,  and  not  unfrequently  finds  it  advantageous 
even  as  regards  pecuniary  interests  when  he  is  compelled 
to  utilise  his  waste  offensive  refuse.  Without  entering 
into  details,  it  may  be  said  generally  that  all  foul  matters 
should  be  conveyed  to  the  works  in  properly-constructed 
vans  or  tanks,  which  can  be  covered  with  tight-fitting  lids, 
and  that  they  should  be  stored  in  closed  chambers  or 
tanks,  ventilated,  if  necessary,  into  the  furnace  fires,  or  to 
special  scrubbers.  All  foul  processes,  such  as  oil-boiling, 
tallow-melting,  and  the  like,  should  be  carried  on  in 
boilers  with  tight-fitting  lids ;  and  the  effluvia  given  off 
should  be  conducted  first  to  a  condenser  to  get  rid  of  the 
steam,  if  necessary,  and  then  to  the  furnace-fire  to  be 
consumed.  The  sulphuretted  hydrogen  and  ammonium 
compounds  which  are  given  off  in  the  manufacture  of 
salts  of  ammonia  from  gas-liquor,  should  also  be  conducted 
from  the  vats  to  the  furnace-fire  to  be  burnt.  Again,  all 
gases  and  vapours  which  can  be  condensed!  or  absorbed 
should  be  passed  through  condensers  or  absorbents  speci- 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  443 

ally  suited  for  them,  as,  for  example,  water  in  the  form  of 
spray,  or  scrubbers  charged  with  water,  sulphuric  acid,  or 
alkaline  solutions. 

In  Dr.  Ballard's  valuable  report  concerning  offensive 
trades,  already  referred  to  in  Chapter  III.,  he  thus  classi- 
fies the  ordinary  sources  of  origin  of  effluvium  nuisances: — 

"1.  Accumulation  of  filth  on  or  about  the  business  premises, 
or  on  its  removal  from  the  premises  in  an  offensive  condition. 

"  2.  A  generally  filthy  condition  of  the  interior  of  the  buildings 
and  the  premises  and  utensils  generally. 

"  3.  An  improper  mode  of  disposing  of  offensive  refuse,  liquid 
or  otherwise. 

"  4.  Insufficient  and  careless  arrangements  in  the  reception  of 
offensive  materials  of  the  trade,  or  in  the  removal  of  offensive  products 
either  from  the  premises,  or  from  one  part  of  the  premises  to  another. 

"  5.  An  improper  mode  of  storing  offensive  material  or  offensive 
products  within  the  works. 

"6.  The  escape  of  offensive  gases  or  vapours  given  off  during 
some  part  or  parts  of  the  processes  to  which  the  materials  of  the 
trade  are  subjected  into  the  atmosphere  outside  the  works." 

The  report  contains  abundant  illustrations  of  the 
modes  in  which  effluvium  nuisances  may  arise  from  busi- 
ness premises,  and  is  replete  with  information  concerning 
methods  in  use,  or  which  may  be  devised  to  obviate  or 
minimise  them  ;  but  without  referring  to  particular  trades 
it  will  be  sufficient  to  indicate  the  general  principles  on 
which  prevention  should  be  based,  and  these  are  laid 
down  by  Dr.  Ballard  as  follows  : — 

"  As  respects  the  first  and  second  of  these  sources  of  effluvium 
nuisances,  the  obvious  remedy  is  '  cleanliness '  in  the  broadest  sense 
of  the  word. 

"  1.  Filth  should  be  removed  from  the  premises  speedily  in  the 
impervious  covered  vessels  in  which  it  ought  always  to  be  collected 
from  time  to  time  during  the  day. 

"2.  Those  parts  of  the  interior  of  premises  liable  to  become 
dirty  or  encrusted  with  filth  or  decomposable  matter,  and  all  the 
ntuiisils  employed,  should  be  regularly  cleansed.  Such  structural 
and  working  arrangements  should  be  made  as  shall  not  only  tend 
to  prevent  such  defilements,  but  also  tend  to  facilitate  cleansing. 


444  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

"  3.  Solid  refuse  should  be  separated  from  liquid  refuse  as  far 
as  practicable,  and  each  should  be  disposed  of  in  its  appropriate 
manner,  the  solids  being  deposited  and  speedily  removed  in  covered 
impervious  vessels,  and  the  liquids  being  run  off  into  proper  drains 
in  such  a  condition  as  not  necessarily  to  give  rise  to  offensive  emana- 
tions. Deodorants  may  sometimes  be  used  with  advantage. 

11  4.  Offensive  matters  necessary  for  use  in  the  business  should 
be  brought  upon  the  premises  either  in  covered  impervious  vessels, 
or  covered  up  in  such  a  manner  that  they  shall  not  be  a  source  of 
effluvium-nuisance  in  transit.  They  should  be  so  received  in  an 
enclosed  building,  and  unloaded  with  due  precaution  against  the 
issue  of  effluvia  in  the  process.  Offensive  products  should  be  re- 
moved similarly  from  the  premises.  Precautions  should  also  be 
used  in  the  removal  of  offensive  products  from  one  part  of  the  pre- 
mises to  another.  Difficulties  in  this  respect  now  and  then  arise  in 
works  from  insufficient  space,  or  bad  arrangements  of  workshops  and 
receptacles.  In  such  cases  as  these,  modifications  may  be  necessary 
in  the  works  themselves. 

"  5.  Offensive  materials  and  products  of  the  business  should 
either  be  stored  in  impervious  vessels  or  in  a  close  chamber,  venti- 
lated, if  necessary,  in  such  manner  that  the  effluvia  shall  not  become 
a  nuisance. 

"  6.  Sometimes  a  careful  selection  of  the  materials  of  the  manu- 
facture, or  some  little  modification  of  the  manner  of  conducting  a 
part  of  the  process,  may  be  sufficient  to  obviate  an  effluvium  nuisance 
wholly  or  partially.  But  when  the  evolution  of  offensive  gases  or 
vapours  is  not  thus  avoidable,  they  must  be  intercepted  in  their 
passage  to  the  external  air,  and  dealt  with  in  such  a  manner  as  to 
destroy  their  offensive  character.  One  method  of  interception  con- 
sists in  arrangements  for  drawing  off  in  a  continuous  manner  the  air 
of  the  entire  chamber  or  workshop  in  which  the  offensive  effluvia  are 
evolved ;  but  mostly  the  interception  is  practicable  without  doing  this. 
When  drawn  off  or  collected,  they  may,  according  to  their  nature,  be 
dealt  with  in  one  of  five  ways  : — (1.)  They  may  be  discharged  into 
the  atmosphere  at  such  an  elevation  as  that  they  shall  be  so  diluted 
before  reaching  the  ground  as  not  to  be  offensive.  When  this  will 
not  suffice,  other  means  must  be  used.  (2.)  If  the  evolved  matters 
be  condensible  by  cold,  they  may  be  passed  through  an  appropriate 
condensing  apparatus.  (3.)  If  soluble  in  water,  they  may  be  sub- 
mitted to  the  action  of  water  in  an  appropriate  apparatus,  or  simi- 
larly, to  the  action  of  any  other  liquid  better  calculated  to  absorb 
them.  (4.)  Sometimes,  in  like  manner,  solid  substances,  with  which 
the  effluvia  have  chemical  affinity,  may  be  used  with  advantage, 
either  in  powder  or  otherwise.  (5.)  If  the  evolved  matters  be  com- 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  445 

bustible,  they  may  be  burned  by  conducting  them  through  a  fire." 
— (Supplement  to  Local  Government  Board  Report,  1876.) 

9.  Unsound  Meat,  etc.   (clauses    116-119). — These 
clauses  empower  the  medical  officer  of  health  or  inspector 
of  nuisances  to  inspect  and  examine,  at  all  reasonable 
times,  "  any  animal,  carcase,  meat,  poultry,  game,  flesh, 
fish,  fruit,  vegetables,  corn,  bread,  flour,  or  milk,  exposed 
for  sale,  or  deposited  in  any  place  for  the  purpose  of  sale,  or 
of  preparation  for  sale,  and  intended  for  the  food  of  man." 

In  carrying  out  his  duties  in  this  respect,  it  is  advis- 
able that  the  medical  officer  of  health,  when  he  is  not 
called  in  by  the  sanitary  inspector,  should  get  that  officer, 
or  failing  him  a  policeman,  to  seize  the  condemned 
articles  in  order  to  have  them  dealt  with  by  a  Justice. 
The  onus  of  proving  that  the  article  seized  was  not  ex- 
posed or  deposited  for  sale,  or  for  preparation  for  sale,  or 
was  not  intended  for  the  food  of  man,  rests  upon  the 
person  charged.  Very  often,  with  regard  to  bad  meat, 
the  defence  set  up  is  that  the  article  seized  was  not  in- 
tended for  the  food  of  man,  but  for  feeding  dogs,  or  to  be 
boiled  down  with  other  offal  as  the  case  may  be.  So  far, 
however,  as  the  medical  officer  of  health  is  concerned,  he 
should  endeavour,  as  far  as  possible,  to  confine  his  evi- 
dence to  the  question  as  to  whether  the  article  seized  is 
or  is  not  fit  for  the  food  of  man,  leaving  the  rest  of  the 
evidence  to  be  given  by  the  sanitary  inspector  or  other 
witnesses.  Various  practical  hints  concerning  the  ex- 
amination of  different  articles  of  food  have  already  been 
given  in  Chapter  II.,  while  medical  officers  of  health,  who 
are  also  appointed  as  public  analysts  under  the  "  Sale  of 
Food  and  Drugs  Act,  1875,"  must  be  specially  qualified. 

10.  Infectious    Diseases?    Hospitals,    Morticaries,    etc. 
(clauses  120-143). — This  part  of  the  subject  has  already 
been  so  fully  discussed  in  previous  chapters  that  little 
more  remains  to  be  said.      The  medical  officer  of  health 


446  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

will  have  to  consider  whether,  in  the  event  of  an  outbreak 
of  epidemic  disease  occurring  in  his  district,  there  can  be 
procured  at  short  notice  sufficient  means  of  isolation.  It 
is  true  that  in  some  rural  districts  the  population  is  so 
very  scattered  that  hospital  accommodation  is  not  re- 
quired, because  sufficiently  protective  measures  can  be 
adopted  by  quarantining,  as  far  as  possible,  any  infected 
houses,  and  by  supplying  properly  trained  nurses,  if  they 
should  be  wanted,  who  may  be  paid  either  by  the  sanitary 
authority,  or,  in  the  case  of  paupers,  by  the  board  of 
guardians.  When  an  outbreak  threatens  to  be  serious,  a 
strict  watch  should  be  kept  on  all  houses  where  infectious 
disease  is  known  to  exist,  and  there  should  be  no  hesita- 
tion in  summoning  any  one  who  wilfully  or  carelessly 
offends  against  any  of  the  clauses  of  the  Act.  In  order 
that  there  may  be  no  excuse  for  pleading  ignorance  in 
this  respect,  the  sanitary  inspector  should  be  supplied 
with  placards  containing  the  necessary  precautions  to  be 
taken  (see  Appendix),  a  copy  of  which  he  should  leave  at 
every  infected  house.  In  inquiring  into  the  origin  of  any 
outbreak,  or  in  giving  instructions  with  regard  to  pre- 
venting its  spread,  it  need  hardly  be  said  that  the  medical 
officer  of  health  should  be  very  careful  not  to  examine 
any  case  without  first  requesting  the  sanction  of  the 
medical  attendant,  and  unless  he  has  reason  to  believe 
that  an  error  has  been  made  in  the  diagnosis,  he  should 
never  question  the  accuracy  of  any  returns  which  may  be 
made  to  him.  He  will  also  have  to  •  consider  whether  it 
is  necessary  that  any  schools  should  be  closed,  and  in 
recommending  that  such  a  step  should  be  taken,  he  should 
always  give  a  certificate  in  the  case  of  public  elementary 
schools,  in  order  that  the  teacher  may  not  be  deprived  of 
the  government  grant  which  is  allowed  on  the  average 
attendance  of  the  pupils.  According  to  a  recent  code 
issued  by  the  Education  Department,  it  is  made  incumbent 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  447 

on  the  managers  of  all  such  schools  to  close  them  for  a 
stated  time  by  order  of  the  sanitary  authority,  on  receipt  of 
the  necessary  certificate  from  the  medical  officer  of  health. 

With  regard  to  the  special  provisions  of  this  section 
of  the  Act,  it  may  be  pointed  out  that  it  is  imposed  as  a 
duty  on  all  sanitary  authorities  to  cause  premises  to  be 
cleansed  or  disinfected,  and  they  are  further  empowered 
to  direct  the  destruction  of  any  bedding,  clothing,  or  other 
articles,  which  cannot  otherwise  be  safely  disinfected,  and 
to  pay  for  the  same ;  to  supply  means  of  disinfection  if 
necessary ;  and  to  provide  ambulances,  hospitals,  and  mor- 
tuaries. They  may  either  build  such  hospitals  or  places 
of  reception,  or  contract  for  the  use  of  any  such  hospital, 
or  part  of  a  hospital,  or  place  of  reception ;  or  enter  into 
any  agreement  with  any  person  having  the  management 
of  any  such  hospital;  or  two  or  more  authorities  may 
combine  in  providing  a  common  hospital.  In  populous 
districts,  it  is  always  advisable  that  a  proper  hospital 
should  be  erected ;  and  in  small  urban  and  rural  districts, 
it  will  often  be  found  that  such  hospital  accommodation 
can  be  most  economically  and  efficiently  provided  by 
combination  of  neighbouring  authorities.  The  term  place 
of  reception  will  include  any  house  which  may  be  rented 
for  the  reception  of  infectious  cases,  or  any  hut  or  tent, 
or,  in  the  case  of  seaport  towns,  any  hospital  ship. 

Clause  132  empowers  a  sanitary  authority  to  recover 
the  cost  of  maintenance  of  any  patient  who  is  treated  in 
any  such  hospital,  who  is  not  a  pauper ;  but  inasmuch  as 
the  removal  of  a  patient  to  a  hospital  may  be  said  to 
confer  as  great  a  benefit  on  the  public  as  it  does  on  the 
patient,  the  enforcement  of  payment  would  not  only  be 
manifestly  unfair  in  many  cases,  but  would  tend  greatly 
to  diminish  the  usefulness  of  such  hospital.  According 
to  clause  124  the  only  persons  who  can  be  removed  to 
an  infectious  hospital  by  order  of  a  justice,  on  a  certifi- 


448  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

cate  signed  by  a  legally  qualified  practitioner,  are  the  fol- 
lowing : — Any  person  who  is  suffering  from  any  dangerous 
infectious  disorder,  who  is  without  proper  lodging  or  ac- 
commodation, or  lodged  in  a  room  occupied  by  more  than 
one  family,  or  is  on  board  any  ship  or  vessel;  or  any 
person  so  suffering  who  is  lodged  in  any  common  lodging- 
house.  With  proper  tact,  however,  on  the  part  of  the 
medical  officer  of  health  in  enlisting  the  co-operation  of 
medical  attendants,  and  readiness  on  the  part  of  the  sani- 
tary authority  to  attend  to  his  recommendations,  there 
will  generally  be  little  difficulty  experienced  in  inducing 
most  patients  to  enter  the  hospital  who  are  fit  to  be  re- 
moved, and  whose  removal  is  considered  advisable  for  the 
public  safety. 

Although  the  sanitary  protection  afforded  by  hos- 
pitals, mortuaries,  disinfecting  apparatus,  and  the  like,  is 
now  placed  beyond  dispute,  it  unfortunately  happens  that 
sanitary  authorities,  as  a  rule,  are  very  slow  to  exercise 
the  powers  vested  in  them  in  this  respect,  unless  under 
the  pressure  of  an  epidemic,  and  consequently  the  recom- 
mendations of  the  medical  officer  of  health  to  be  prepared 
beforehand  are  often  thrown  aside.  But  this  need  not 
discourage  or  annoy  him  in  any  way.  His  plain  duty  is 
to  study  carefully  the  requirements  of  his  district,  and 
having  done  this  to  submit  his  views  as  clearly  and  as 
concisely  as  he  can  to  the  sanitary  authority,  using  the 
best  arguments  he  can  advance  to  support  his  case,  show- 
ing every  readiness  to  answer  any  questions,  and  being 
fully  prepared  to  meet  any  objections.  If  his  recommen- 
dations are  not  complied  with,  the  onus  will  rest  on  the 
sanitary  authority,  and  not  on  him ;  but  at  the  same 
time  he  should  be  careful  to  bring  them  forward  on  some 
future  occasion,  when  very  likely  they  will  either  meet 
with  acceptance,  or  at  all  events  some  efforts  will  probably 
be  made  to  carry  them  out. 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  449 

Clauses  134  to  140  empower  the  Local  Government 
Board,  whenever  any  formidable  outbreak  takes  place  in 
any  part  of  England,  to  make  regulations  for  the  speedy 
interment  of  the  dead,  for  house-to-house  visitation,  for 
medical  aid  and  accommodation,  and  for  other  means  to 
prevent  the  spread  of  disease ;  but  it  will  only  be  in  cases 
of  the  gravest  emergency,  and  when  the  health  of  his 
district  is  seriously  endangered,  that  the  medical  officer  of 
health  will  feel  it  incumbent  on  him  to  recommend  the 
enforcement  of  these  clauses. 

In  all  cases  of  infectious  disease,  care  should  be  taken 
to  ensure  as  far  as  possible  the  right  use  of  disinfectants, 
and  it  is  always  a  wise  economy  on  the  part  of  sanitary 
authorities  to  supply  disinfectants  gratuitously  to  those 
who  are  too  poor  to  buy  them.  Moreover,  as  it  is  the 
duty  of  the  sanitary  authority  to  take  care  that  disinfec- 
tion is  efficiently  carried  out,  the  sanitary  inspector,  under 
the  direction  of  the  medical  officer  of  health,  should  him- 
self superintend  or  assist  in  the  process  of  the  disinfection 
of  rooms,  etc.,  or  in  populous  districts  some  one  should  be 
specially  appointed  to  act  as  a  disinfector. 

For  detailed  information  with  regard  to  hospitals, 
infectious  disease,  etc.,  see  Chapters  X.  and  XIV.,  and 
Appendix. 

11.  The  other  clauses  in  the  Public  Health  Act  which 
are  of  special  interest  to  the  medical  officer  of  health  are 
the  following,  and  they  apply  exclusively  to  urban  dis- 
tricts, or  districts  provided  with  urban  powers  : — 

Clause  157  gives  power  to  make  by-laws  respecting 
new  buildings,  etc. 

Clause  164  empowers  an  urban  sanitary  authority  to 
provide  places  of  public  recreation. 

clause  166  gives  power  to  provide  markets. 

Clauses  169-170  give  power  to  provide  public  slaugh- 
ter-houses, and  to  regulate  private  slaughter-houses. 
2  G 


450  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

In  Schedule  IV.  of  the  Act  will  be  found  the  various 
legal  forms  of  notice  for  requiring  the  abatement  of  nuis- 
ance, summons,  etc.,  but  these  concern  the  clerk  and. 
sanitary  inspector  more  than  they  do  the  medical  officer 
of  health. 

12.  The  other  Acts  which  have  not  been  repealed 
by  the  Public  Health  Act,  to  which  reference  may  be 
made,  are  the  Artisans'  and  Labourers'  Dwellings  Act, 
the  Bakehouse  Eegulation  Act,  and  the  Baths  and  Wash- 
houses  Act,  but  as  the  essential  provisions  of  these  are 
included  in  the  by-laws  of  all  urban  districts  in  which 
they  are  in  force,  they  need  not  be  further  considered 
here. 

In  towns"  containing  a  population  of  25,000  and  up- 
wards, as  enumerated  at  the  last  census,  an  important 
duty  will  devolve  upon  the  medical  officer  of  health  of 
recommending  the  adoption  of  the  Artisans'  Dwellings 
Acts  of  1875,  when  any  houses,  courts,  or  alleys,  within 
a  certain  area  of  his  district,  are  unfit  for  habitation  by 
reason  of  their  unhealthiness,  and  when  the  sanitary 
defects  in  such  area  cannot  be  effectually  remedied  other- 
wise than  by  an  improvement  scheme.  As  the  local 
authority  cannot  carry  out  the  intentions  of  the  Act  with- 
out an  official  representation  made  by  the  medical  officer 
of  health,  and  as  he  is  bound  by  the  Act  to  make  such 
representation  whenever  he  sees  cause  for  the  same,  it 
need  hardly  be  said  that  the  duty  imposed  upon  him 
will  demand  the  utmost  care  and  conscientiousness  on  his 
part. 

The  provisions  of  the  Public  Health  (Water)  Act 
have  already  been  referred  to,  and  the  only  other  Acts 
with  which  the  medical  officer  of  health  should  make 
himself  familiar  are  the  Sale  of  Food  and  Drugs  Act, 
18*75,  and  the  Canal  Boats  Act,  1877.  The  latter  Act 
empowers  the  Local  Government  Board  to  appoint  sani- 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  451 

tary  authorities  having  districts  abutting  on  a  canal  as 
registration  authorities  to  register  boats  and  number 
them,  and  to  fix  the  number,  age,  and  sex  of  the  persons 
who  may  be  allowed  to  dwell  in  each  boat.  Eegulations 
are  also  provided  for  the  separation  of  the  sexes,  cleanli- 
ness, ventilation,  habitable  condition,  and  for  preventing 
the  spread  of  infectious  diseases. 

13.  By -Laws. — In   all  urban  districts,  the  medical 
officer  of  health  will  find  that  by-laws  have  already  been 
framed,  and  as  a  matter  of  course  he  should  at  once  make 
himself  thoroughly   acquainted   with    their   details,   and 
more  especially  with  those  which  relate  to  the  removal  of 
refuse  and  the  prevention  of  nuisance,  the  sanitary  arrange- 
ments of  new  buildings,  and  the  inspection  and  regulation 
of  slaughter-houses,  bakehouses,   and   common   lodging- 
houses.     Unfortunately,  rural  sanitary  authorities  have  no 
power   to  issue  by-laws  with  respect  to  new  buildings, 
etc.,  unless  they  are  provided  with  urban  powers ;  but 
since   these  can  be  granted   by  the  Local  Government 
Board,  it  will  become  the  duty  of  the  medical  officer  of 
health  to  recommend  that  an  application  be  made  for  the 
granting  of  such  powers,  whenever  he  feels  assured  that 
the  sanitary  requirements  of  his  district  demand  them.    In 
order  that  he  may  be  fully  qualified  to  advise  the  sani- 
tary authority  with  regard  to  the  framing   of  by-laws 
when  required,  the  medical  officer  of  health  should  make 
himself  thoroughly  acquainted  with   the   code  of  model 
by-laws  which  have  been  issued  by  the  Local  Govern- 
ment Board. 

14.  Legal  Proceedings. —  Unless    under    exceptional 
circumstances,  the  medical  officer  of  health  should  never 
conduct  a  case  before  the  Justices, — that  is  the  duty  of 
the  clerk  to  the  sanitary  authority,  or  in  respect  to  com- 
mon nuisances,  it  is  often  discharged  by  the  sanitary  in- 
spector.    Although  he  will  often  have  to  recommend  that 


452  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

proceedings  be  taken,  his  duty,  so  far  as  the  prosecution 
is  concerned,  should  be  confined  to  furnishing  a  certificate 
or  giving  evidence  when  required.  With  a  well-trained 
inspector,  it  is  seldom  that  he  will  be  required  to  give 
evidence  except  as  regards  cases  of  overcrowding,  infected 
houses,  or  exposure  of  infected  persons,  clothing,  etc., 
unsound  meat,  nuisances  which  are  likely  to  be  contested, 
and  offensive  trades. 

15.  Routine  of  Duty. — This  of  course  will  very 
much  depend  on  the  nature  and  extent  of  the  district. 
It  unfortunately  happens  that  in  many  instances  the 
appointment  of  medical  officer  of  health  is  made  under 
circumstances  in  which  he  is  expected  to  do  but  little, 
and  that  little  only  when  called  upon  by  the  sanitary 
inspector  to  certify  or  give  evidence.  But  in  all  large 
urban  or  combined  districts,  it  is  necessary  that  the  duties 
should  be  carried  on  as  systematically  as  possible.  As 
already  stated,  the  sanitary  inspector  or  inspectors  should 
be  under  the  supervision  of  the  medical  officer  of  health, 
and  any  orders  from  the  sanitary  authority  affecting  the 
duties  of  these  officials  should  be  conveyed  through  him 
or  with  his  concurrence,  otherwise  he  cannot  be  held 
responsible  for  the  efficient  working  of  his  department. 
The  following  are  the  duties  of  the  sanitary  inspector  as 
laid  down  by  an  order  of  the  Local  Government  Board, 
dated  November  11,  1872,  and  they  apply  to  all  in- 
spectors who  are  appointed  subject  to  the  approval  of 
that  Board : — 

"  The  following  shall  be  the  duties  of  the  inspector  of  nuisances 
in  respect  of  the  district  for  which  he  is  appointed,  or  if  he  shall 
be  appointed  for  more  than  one  district,  then  in  respect  of  each  of 
such  districts  : — 

*"(!.)  He  shall  perform,  either  under  the  special  directions  of 
the  sanitary  authority,  or  (so  far  as  authorised  by  the 
sanitary  authority)  under  the  directions  of  the  medical 
officer  of  health,  or  in  cases  where  no  such  directions 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  453 

are  required,  without  such  directions,  all  the  duties 
specially  imposed  upon  an  inspector  of  nuisances  by 
the  Sanitary  Acts,  or  by  the  orders  of  the  Local  Govern- 
ment Board. 

"(2.)  He  shall  attend  all  meetings  of  the  sanitary  authority 
when  so  required. 

"(3.)  He  shall  by  inspection  of  the  district,  both  systematically 
at  certain  periods,  and  at  intervals  as  occasion  may 
require,  keep  himself  informed  in  respect  of  the  nuis- 
ances existing  therein  that  require  abatement  under 
the  Sanitary  Acts. 

"  (4.)  On  receiving  notice  of  the  existence  of  any  nuisance  within 
the  district,  or  of  the  breach  of  any  bye-laws  or  regula- 
tions made  by  the  sanitary  authority  for  the  suppres- 
sion of  nuisances,  he  shall,  as  early  as  practicable,  visit 
the  spot,  and  inquire  into  such  alleged  nuisance  or 
breach  of  bye-laws  or  regulations. 

"  (5.)  He  shall  report  to  the  sanitary  authority  any  noxious  or 
offensive  businesses,  trades,  or  manufactories  established 
within  the  district,  and  the  breach  or  non-observance 
of  any  bye-laws  or  regulations  made  in  respect  of  the 
same. 

"  (6.)  He  shall  report  to  the  sanitary  authority  any  damage  done 
to  any  works  of  water-supply,  or  other  works  belonging 
to  them,  and  also  any  case  of  wilful  or  negligent 'waste 
of  water  supplied  by  them,  or  any  fouling,  by  gas,  filth, 
or  otherwise,  of  water  used  for  domestic  purposes. 

"(7.)  He  shall  from  time  to  time,  and  forthwith  upon  com- 
plaint, visit  and  inspect  the  shops  and  places  kept  or 
used  for  the  sale  of  butchers'  meat,  poultry,  fish,  fruit, 
vegetables,  corn,  bread,  or  flour,  or  as  a  slaughter-house, 
and  examine  any  animal,  carcase,  meat,  poultry,  game, 
flesh,  fish,  fruit,  vegetables,  corn,  bread,  or  flour,  which 
may  be  therein  ;  and  in  case  any  such  article  appear 
to  him  to  be  intended  for  the  food  of  man,  and  to  be 
unfit  for  such  food,  he  shall  cause  the  same  to  be  seized ; 
and  take  such  other  proceedings  as  may  be  necessary 
iii  order  to  have  the  same  dealt  with  by  a  justice  : 
Provided  that  in  any  case  of  doubt  arising  under  this 
clause  he  shall  report  the  matter  to  the  medical  officer 
of  health,  with  the  view  of  obtaining  his  advice  thereon. 

"  (8.)  He  shall,  when  and  as  directed  by  the  sanitary  authority, 
procure  and  submit  samples  of  food  or  drink,  and  drugs 
-uspected  to  be  adulterated,  to  be  analysed  by  the 


454  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

analyst  appointed  under  the  Adulteration  of  Food  Act, 
1872  ;  and  upon  receiving  a  certificate  stating  that  the 
articles  of  food  or  drink,  or  drugs,  are  adulterated, 
cause  a  complaint  to  be  made,  and  take  the  other  pro- 
ceedings prescribed  by  that  Act. 

"  (9.)  He  shall  give  immediate  notice  to  the  medical  officer  of 
health  of  the  occurrence  within  his  district  of  any  con- 
tagious, infectious,  or  epidemic  disease  of  a  dangerous 
character  ;  and  whenever  it  appears  to  him  that  the 
intervention  of  such  officer  is  necessary  in  consequence 
of  the  existence  of  any  nuisance  injurious  to  health,  or 
of  any  overcrowding  in  a  house,  he  shall  forthwith  in- 
form the  medical  officer  thereof. 

"  (10.)  He  shall,  subject  in  all  respects  to  the  directions  of  the 
sanitary  authority,  attend  to  the  instructions  of  the 
medical  officer  of  health  with  respect  to  any  measures 
which  can  be  lawfully  taken  by  him  under  the  Sanitary 
Acts  for  preventing  the  spread  of  any  contagious,  in- 
fectious, or  epidemic  disease  of  a  dangerous  character. 

"  (11.)  He  shall  enter  from  day  to  day,  in  a  book  to  be  provided 
by  the  sanitary  authority,  particulars  of  his  inspections 
and  of  the  action  taken  by  him  in  the  execution  of  his 
duties.  He  shall  also  keep  a  book  or  books,  to  be  pro- 
vided by  the  sanitary  authority,  so  arranged  as  to  form, 
as  far  as  possible,  a  continuous  record  of  the  sanitary 
condition  of  each  of  the  premises  in  respect  of  which 
any  action  has  been  taken  under  the  sanitary  Acts,  and 
shall  keep  any  other  systematic  records  that  the  sanitary 
authority  may  require. 

"  (12.)  He  shall  at  all  reasonable  times,  when  applied  to  by  the 
medical  officer  of  health,  produce  to  him  his  books,  or 
any  of  them,  and  render  to  him  such  information  as 
he  may  be  able  to  furnish  with  respect  to  any  matter 
to  which  the  duties  of  inspector  of  nuisances  relate. 

"  (13.)  He  shall,  if  directed  by  the  sanitary  authority  to  do  so, 
superintend  and  see  to  the  due  execution  of  all  works 
which  may  be  undertaken  under  their  direction  for  the 
suppression  or  removal  of  nuisances  within  the  district. 

"f  14.)  In  matters  not  specifically  provided  for  in  this  order,  he 
shall  observe  and  execute  all  the  lawful  orders  and 
directions  of  the  sanitary  authority,  and  the  orders  of 
the  Local  Government  Board  which  may  be  hereafter 
issued,  applicable  to  his  office." 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  455 

In  some  valuable  articles  which  appeared  in  the 
Medical  Times  and  Gazette  in  Nov.  1872,  on  the  duties 
of  medical  officers  of  health,  the  following  sketch  of  the 
daily  routine  in  a  large  metropolitan  parish  is  given  as  a 
guide  for  commencing  health  officers  : — 

"  At  9  A.M.  the  subordinate  officers  arrive  at  the  office.  They 
consist  of  a  clerk,  a  messenger  (who  is  always  a  copying  clerk),  the 
sanitary  inspectors,  to  each  of  whom  a  district  is  assigned,  and  a 
disinfector.  Shortly  after  the  medical  officer  arrives,  reads  his 
letters,  confers  with  the  clerk,  gives  directions  as  to  the  correspond- 
ence of  the  day,  receives  verbal  reports  from  the  inspectors  as  to  the 
previous  day's  work,  and  makes  appointments  for  these  officers  to 
meet  him  at  particular  places  during  the  course  of  the  day,  should 
his  presence  be  deemed  necessary  in  particular  cases.  In  a  few 
minutes  a  large  amount  of  routine  work  can  thus  be  got  through, 
whilst  reports  for  committees,  special  correspondence,  and  the  ex- 
amination of  the  books  of  the  department,  can  be  despatched,  say 
twice  or  thrice  a  week,  at  any  convenient  time.  Between  9  and  10 
A.M.  each  inspector  writes  out  a  brief  diary  of  his  previous  day's 
work  for  the  information  of  the  medical  officer,  and  instructs  the 
disinfector  as  to  houses  where  disinfection  is  required.  At  10  the 
sanitary  inspectors  depart  on  their  daily  rounds,  having  previously 
informed  themselves  as  to  any  new  complaints  requiring  their  atten- 
tion. After  their  departure  the  clerk  extracts  and  summarises  their 
diaries,  and  enters  the  results  in  the  proper  books.  The  books 
actually  in  use  are — (1.)  The  medical  officer's  diary,  in  which  he 
briefly  enters  the  dates  of  visits  made,  with  any  particulars  he 
thinks  fit.  (2.)  A  book  for  receiving  the  complaints  of  ratepayers 
and  others.  (3.)  A  record  of  houses  in  which  infectious  disease  has 
appeared.  (4.)  The  diaries  of  the  several  sanitary  inspectors.  (5.) 
A  book  recording  the  progress  of  works,  which  exhibits  at  a  glance 
the  visits  made  and  the  works  executed  at  any  particular  house. 
From  this  the  clerk  extracts,  and  presents  weekly  to  the  medical 
officer — (6.)  A  list  of  works  in  arrear.  (7.)  A  report  book  in  which 
the  health  officer  reports  to  the  sanitary  committee  all  ordinary 
cases  of  nuisances  uncompleted,  together  with  his  recommendations. 
Further,  the  sanitary  inspector:;  are  provided  with  forms  of  notices 
of  nuisances,  arranged  in  books  with  duplicates,  after  the  manner  of 
a  cheque-book.  These  arrangements  may  seem  complicated.  In 
practice,  however,  they  are  found  to  be  simple  arid  effective.  Where 
little  or  no  clerical  assistance  is  furnished,  they  may  be  much 
simplified,  and  the  books  reduced  in  number." 


456  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

In  small  urban  or  rural  districts,  and  in  combined 
districts  when  special  clerical  assistance  is  not  required, 
the  only  book  which  it  may  be  necessary  to  keep  beyond 
filing  statistics,  reports,  and  any  important  official  com- 
munications, is  a  diary,  but  this  should  always  be  kept, 
no  matter  how  meagre  the  duties  may  be,  because  it  will 
be  frequently  required  for  reference. 

16.  Eeports. — All  reports  from  the  health  officer  to 
the  sanitary  authority  should  be  concise  and  to  the  point. 
The  stated  reports,  weekly,  quarterly,  or  otherwise,  will 
deal  chiefly  with  the  vital  statistics  of  the  district,  and 
enumerate  such  proceedings  as  have  been  undertaken, 
according  to  the  provisions  of  the  Sanitary  Acts,  together 
with  any  suggestions  which  he  may  deem  it  to  be  his 
duty  to  lay  before  the  sanitary  authority  from  time  to 
time.  He  should  avoid  entering  into  lengthy  disquisitions, 
because  he  will  have  the  opportunity,  at  meetings  of  the 
sanitary  authority,  of  answering  any  questions,  and  justify- 
ing his  recommendations,  should  he  be  called  upon  to  do 
so.  As  far  as  possible  he  should  base  his  stated  reports 
on  a  uniform  plan,  and  he  may  be  quite  ,sure  that  the 
briefer  they  are  in  their  completeness,  the  more  they  will 
be  appreciated.  Annual  reports  should  embrace  all  the 
points  indicated  in  the  regulations  of  the  Local  Govern- 
ment Board,  previously  quoted.  (For  official  instructions 
see  Appendix.) 

If  his  reports  appear  in  the  public  newspapers  of  the 
district,  as  will  generally  be  the  case,  he  should  endeavour, 
without  being  diffuse,  to  make  them  readable  and  instruc- 
tive, and  whenever  he  considers  it  necessary  to  address 
the  public  through  this  channel,  with  respect  to  any 
sanitary  dangers  to  which  they  may  be  specially  exposed, 
it  is  always  advisable  that  his  remarks  should,  in  the  first 
instance,  be  submitted  to  the  sanitary  authority.  Although 
he  will  find  the  press  to  be  of  great  assistance  in  educating 


DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH.  457 

the  public  in  sanitary  matters,  it  need  hardly  be  said  that 
he  should  avoid  entering  into  controversy,  and  that  he 
should  be  very  careful  not  to  drag  the  names  of  private 
individuals  before  the  public  when  his  reports  are  printed. 

17.  Official  Conduct. — With  regard  to  his  subordinates, 
the  medical  officer  should  endeavour  to  arouse  in  them  an 
esprit  de  corps,  not  doing  their  work,  but  seeing  that  they 
do  it  themselves  efficiently  and  readily.  He  should  listen 
courteously  to  any  remarks  or  suggestions  which  they 
may  make,  and  if  they  are  trained  officers,  give  them  credit 
for  knowing  their  duties  as  well  as  he  does  his  own.  In 
their  own  sphere  they  are  as  sensitive  to  rebuke  as  him- 
self, and  it  should,  therefore,  never  be  administered  unless 
it  is  merited.  Any  serious  delinquency  or  inefficiency  on 
their  part  should  be  laid  before  the  sanitary  authority, 
and  those  who  do  perform  their  duties  satisfactorily  should 
be  as  frankly  commended.  Above  all,  punctuality  should 
be  insisted  on.  In  cases  where  the  health  officer  will  have 
to  educate  sanitary  inspectors  who  are  new  to  the  work,  it 
would  be  desirable  that  all  candidates  for  stich  an  important 
post  should  pass  a  certain  period  of  probation  before  their 
appointment  is  confirmed  by  the  sanitary  authority. 

As  regards  the  portion  of  the  community  committed 
to  his  charge,  he  should  endeavour,  conscientiously  and 
to  the  best  of  his  ability,  to  fulfil  his  obligations  towards 
them,  and  if  in  practice,  he  should  in  no  wise  shirk  his 
public  duty,  even  at  the  risk  of  losing  his  best  patient. 
In  this,  as  in  all  other  affairs  of  life  and  conduct,  it  will 
be  found  that  in  the  long  run  "  honesty  is  the  best  policy." 

Towards  his  medical  brethren  he  should  religiously 
observe  the  ethics  of  his  profession,  and  act  up  to  the 
golden  rule, — "  Do  to  others  as  you  would  be  done  by." 
He  should  endeavour  to  be  on  friendly  terms  with  all 
within  his  district,  and  never  hesitate  to  court  their  assist- 
ance and  advice  when  he  feels  that  he  may  require  them 


458  DUTIES  OF  MEDICAL  OFFICERS  OF  HEALTH. 

in  the  discharge  of  his  duties.  It  need  hardly  be  said 
that  all  such  favours  or  obligations  should  be  readily  and 
ungrudgingly  reciprocated  on  his  part.  If  he  is  not  de- 
barred from  private  practice,  he  should  be  careful,  above 
all  things,  not  to  take  advantage  of  his  public  office  by 
using  it  as  a  means  to  increase  the  number  of  his  patients. 
This,  to  say  the  least,  would  be  a  grave  breach  of  profes- 
sional etiquette,  which  would  deservedly  arouse  remon- 
strance and  opposition  on  the  part  of  his  medical  brethren. 
His  relations  to  the  sanitary  authority  or  sanitary 
committee,  as  the  case  may  be,  should  be  guided  by 
common  sense  and  a  sense  of  duty.  He  should  always 
remember  that  he  is  their  medical  adviser,  not  their  dic- 
tator ;  and  at  their  meetings  he  should  carefully  avoid 
taking  part  in  discussions  on  his  reports,  unless  called 
upon  to  do  so,  or  in  reply  to  objections.  He  should  at- 
tend all  meetings  at  which  his  presence  is  requested  or 
expected ;  and  when  he  does  attend,  he  should  support 
his  views,  when  called  upon,  with  clearness,  firmness, 
courtesy,  and  tact.  His  proposals  may  be  rejected,  but  if 
they  do  not  lie  within  the  scope  of  the  statutory  enact- 
ments requiring  their  enforcement,  he  should  never  resent 
opposition,  but  again  bring  them  forward  on  future  occa- 
sions. But  with  regard  to  breaches  of  sanitary  law,  which 
in  spite  of  his  representations  may  be  persistently  ignored, 
he  should  unhesitatingly  insist  upon  their  being  remedied, 
and,  failing  action,  he  can  always  appeal  to  the  Local 
Government  Board.  It  is  to  be  hoped,  however,  that  he 
will  seldom  meet  with  such  unwarrantable  opposition. 
Under  all  circumstances  he  should  strive  to  exercise  a 
wise  forbearance  when  he  can  conscientiously  do  so,  and 
on  all  occasions  maintain  a  courteous,  dignified,  and  friendly 
demeanour  towards  the  sanitary  authority,  feeling  assured 
that  tact  and  good  temper,  like  good  words,  "  are  worth 
much,  and  cost  but  little." 


APPENDIX. 


OFFICIAL  MEMORANDA  AND  OTHER  DATA. 

I. — The  DAIRIES,  COW-SHEDS,  and  MILK-SHOPS  ORDER  of 
1879,  issued  4th  February  1879. 

1.  Preliminary. — This  Order  may  be  cited  as  The  Dairies,  Cow- 
Sheds,  and  Milk-Shops  Order  of  1879. 

2.  This  Order  shall  take  effect  from  and  immediately  after  the 
making  thereof. 

3.  This  Order  extends  to  Great  Britain  only. 

4.  In  this  Order — 

The  Act  of  1878  means  The  Contagious  Diseases  (Animals)  Act, 

1878; 
Other  terms  have  the  same  meaning  as  in  the  Act  of  1878. 

5.  Registration  of  Cow -Keepers  and  others. — (1.)   Every  Local 
Authority  shall,  with  all  practicable  speed  after  the  making  of  this 
Order,  open,  and  shall  thenceforth  keep,  a  register  for  the  registra- 
tion with  them  under  this  Order  of  all  persons  from  time  to  time 
currying  on  in  their  district  the  trade  of  cow-keepers,  dairymen,  or 
purveyors  of  milk,  and  shall,  from  time  to  time,  revise  and  correct 
the  register. 

(2.)  The  Local  Authority  shall  give  public  notice,  by  advertise- 
ment in  a  newspaper  circulating  in  their  district,  and,  if  they  think 
fit,  by  placards,  handbills,  or  otherwise,  of  the  time  at  which  the 
register  will  be  opened,  and  of  the  mode  of  registration. 

(3.)  After  the  expiration  of  the  time  prescribed  in  this  behalf  in 
the  advertisement,  not  being  more  than  two  months,  and  not  being 
leefl  than  fourteen  days,  from  the  publication  of  the  advertisement, 
it  shall  not  be  lawful  for  any  person  to  cany  on  in  the  district  of 
the  Local  Authority  the  trade  of  a  cow-keeper,  dairyman,  or  pur- 
veyor of  milk,  unless  he  is  registered  as  such  under  this  Order. 

6.  Dairies  and  Coio-Sheds. — It  shall  not  be  lawful  for  any  person 


460  APPENDIX. 

following  the  trade  of  cow-keeper  or  dairyman  to  begin  to  occupy  as 
a  dairy  or  cow-shed  any  building  not  so  occupied  at  the  making  of 
this  Order,  unless  and  until  he  first  makes  provision,  to  the  reason- 
able satisfaction  of  the  Local  Authority,  for  the  lighting,  ventilation, 
cleansing,  drainage,  and  water-supply,  of  the  same,  while  occupied 
as  a  dairy  or  cow-shed. 

7.  It  shall  not  be  lawful  for  any  person  following  the  trade  of 
cow-keeper  or  dairyman  to  occupy  as  a  dairy  or  cow-shed  any  build- 
ing, whether  so  occupied  at  the  making  of  this  Order  or  not,  if  and 
as  long  as  the  lighting,  ventilation,  cleansing,  drainage,  and  water- 
supply  thereof  are  not  such  as  are  necessary  or  proper — 

(a.)  for  the  health  and  good  condition  of  the  cattle  therein  ;  and 
(&.)  for  the  cleanliness  of  milk-vessels  used  therein  for  contain- 
ing milk  for  sale  ;  and 

(c.)  for  the  protection  of  the  milk  therein  against  infection  and 
contamination . 

8.  Cleansing. — A  Local  Authority  may,  from  time  to  time,  make 
regulations  for  prescribing  and  regulating  the  cleansing  of  dairies 
and  cow-sheds  in  the  occupation  of  persons  following  the  trade  of 
cow-keepers  or  dairymen,  and  the  cleansing  of  milk-stores,  milk- 
shops,  and  milk-vessels  used  for  containing  milk  for  sale  by  such 
persons. 

9.  Contamination  of  Milk. — If  at  any  time  disease  exists  among 
the  cattle  in  a  dairy  or  cow-shed,  or  other  building  or  place,  the 
milk  of  a  diseased  cow  therein — 

(a.)  shall  not  be  mixed  with  other  milk  ;  and 
(6.)  shall  not  be  sold  or  used  for  human  food  ;  and 
(c.)  shall  not  be  sold  or  used  for  food  of  swine  or  other  animals, 
unless  and  until  it  has  been  boiled. 

10.  It  shall  not  be  lawful  for  any  person  following  the  trade  of 
cow-keeper,  or  dairyman,  or  purveyor  of  milk,  or  being  the  occupier 
of  a  milk-store  or  milk-shop,  to  allow  any  person  suffering  from  a 
dangerous  infectious  disorder,  or  having  recently  been  in  contact 
with  a  person  so  suffering,  to  milk  cows,  or  to  handle  vessels  used 
for  containing  milk  for  sale,  or  in  any  way  to  take  part  or  assist  in 
the  conduct  of  the  trade  or  business  of  the  cow-keeper,  dairyman, 
purveyor  of  milk,  or  occupier  of  the  milk-store  or  milk-shop,  as  far 
as  regards  the  production,  distribution,  or  storage  of  milk,  until  all 
danger  therefrom  of  the  commtfnication  of  infection  to  the  milk,  or 
of  its  contamination,  has  ceased. 

11.  It  shall  not  be  lawful  for  a  person  following  the  trade  of 
cow-keeper,  or  dairyman,  or  purveyor  of  milk,  or  being  the  occupier 
of  a  milk-store  or  milk-shop,  to  use  a  milk-store  or  milk-shop  in  his 
occupation,  or  permit  the  same  to  be  used,  for  any  purpose  incom- 


APPENDIX.  461 

patible  with  the  proper  preservation  of  the  cleanliness  of  the  milk- 
store  or  milk-shop,  and  of  the  milk-vessels  and  milk  therein,  or  in 
any  manner  likely  to  cause  contamination  of  the  milk  therein. 

C.  L.  PEEL. 

II. — MEMORANDUM   on  HOSPITAL  ACCOMMODATION,   to  be 
given  by  LOCAL  AUTHORITIES.— (See  Chap.  X.) 

III.  — AMBULANCES. 

For  the  conveyance  to  hospital  of  patients  who  are  sick  with  in- 
fectious disease,  special  carriages,  which  are  known  by  the  name  of 
"  ambulances,"  are  necessary.  Such  carriages  may  be  provided  by 
sanitary  authorities  under  §  24  of  the  Sanitary  Act,  1866.1  The 
following  points  have  to  be  attended  to  in  the  provision  and  use  of 
such  carriages  : — 

1.  If  the  ambulance  be  intended  only  for  journeys  of  not  more 
than  a  mile,  it  may  be  made  so  as  to  be  carried  between  two  people, 
or  it  may  be  on  wheels  and  to  be  drawn  by  hand.     If  the  distance 
be  above  a  mile,  the  ambulance  should  be  drawn  by  a  horse.    Every 
ambulance  on  wheels  should  have  easy  carriage-springs. 

2.  In  the  construction  of  an  ambulance,  special  regard  should 
be  had  to  the  fact  that  after  each  use  it  has  to  be  cleansed  and  dis- 
infected.    The  entire  interior,  and  the  bed-frame  and  bed,  should 
be  of  materials  that  can  be  washed. 

3.  The  ambulance  should  be  such  that  the  patient  can  lie  full 
length  in  it ;  and  the  bed-frame  and  bed  should  be  movable,  so  that 
the  patient  can  be  arranged  upon  the  bed  before  being  taken  out  of 
his  house. 

4.  With  an  ambulance  there  should  always  be  a  person  specially 
in  charge  of  the  patient ;  and  a  horse-ambulance  should  have  a  seat 
for  such  person  inside  the  carriage. 

5.  After  every  use  of  an  ambulance  for  infectious  disease,  it 
should  be  cleansed  and  disinfected  to  the  satisfaction  of  a  medical 
officer. 

6.  Both  in  very  populous  districts,  and  in  districts  which  are  of 
very  wide  area,  it  may  often  happen  that  more  than  one  ambulance 
will  be  wanted  at  one  time  ;  and,  in  any  district,  if  more  than  one 
infectious  disease  is  prevailing,  there  will  be  an  evident  sanitary 
advantage  in  having  more  than  one  ambulance  for  use. 

JOHN  SIMON. 

Medical  Department  of  the  Local  Government  Board, 
December  1874. 

1  §  123  of  the  Public  Health  Act,  1875. 


462  APPENDIX. 


IV. — RULES  drawn  up  by  the  AUTHOR  for  the  SOLIHULL 
HOSPITAL  for  INFECTIOUS  DISEASES. 

KULES  TOR  MEDICAL  OFFICER,  MASTER,  AND  MATRON. 

1.  The  Medical  Officer  shall  be  the  responsible  head  of  the 
establishment,  and  shall  visit  occasionally,  even  when  there  are  no 
patients,  to  assure  himself  that  the  master  and  matron  are  attending 
to  their  duties. 

2.  It  shall  be  the  duty  of  the  master  and  matron  to  keep  the 
wards  scrupulously  clean,  and  to  have  the  bedding  well  aired  and 
in  readiness  at  all  times  for  the  reception  of  patients.     They  shall 
keep  an  inventory  of  everything  belonging  to  the  hospital,  and  a 
careful  record  of  the  articles  of  food  and  drink  supplied  to  patients 
by  the  order  of  the  medical  officer  or  other  medical  attendant.     One 
of  them  shall  always  be  at  the  hospital,  unless  when  special  leave 
is  granted  by  the  sanitary  authority  or  their  clerk.     They  shall 
obey  the  instructions  of  the  medical  officer,  and  be  responsible  for 
the  good  conduct  of  nurses  and  patients. 

3.  The  master  shall  attend  the  board  meetings  at  Solihull  at 
least  once  a  month,  to  submit  his  books  and  take  orders  for  neces- 
saries. 

RULES  FOR  PATIENTS  AND  FRIENDS. 

1.  No  person  shall  be  admitted  to  the  hospital  without  the  pro- 
duction of  a  certificate  signed  by  a  duly  qualified  medical  practi- 
tioner. 

2.  Any  patient  admitted  into  the  hospital  may  be  attended  by 
any  qualified  medical  practitioner,  provided  that  a  request  to  this 
effect  is  submitted  to  the  medical  officer  or  sanitary  inspector  at  the 
time  of  admission,  and  that  the  cost  of  such  attendance  is  defrayed 
by  the  patient  or  friends. 

3.  No  visitor  shall  be  allowed  inside  the  building  or  grounds 
without  written  permission  from  the  medical  officer. 

4.  No  patient  shall  leave  the  wards  or  take  exercise  in  the 
grounds  without  permission  from  the  medical  officer  or  medical 
attendant. 

5.  Any  patient  leaving  the  hospital,  without  the  written  per- 
mission of  the  medical  officer  or  medical  attendant,  will  be  liable  to 
heavy  penalties,  which  will  be  enforced  by  the  sanitary  authority. 

6.  No  patient  shall  leave  the  hospital  without  a  change  of 
clothes,   unless  the  clothing  used  during  convalescence  has  been 
carefully  disinfected. 


APPENDIX.  463 

7.  No  person  in  attendance  upon  patients  shall  leave  the  hos- 
pital without  permission  from  the  medical  officer,  nor  without  a 
change  of  clothes. 

V. — MEMORANDUM  on  the  STEPS  specially  requisite  to  be 
taken  by  BOARDS  of  GUARDIANS  under  the  VACCINA- 
TION ACTS  1867  and  1871,  in  places  in  which  SMALL- 
POX is  EPIDEMIC. 

As  it  is  by  vaccination  that  the  spread  of  smallpox  can  most 
effectually  be  prevented,  Boards  of  Guardians,  as  soon  as  any  case 
of  that  disease  is  brought  into  or  occurs  in  their  respective  Unions 
or  Parishes,  should  see  that  measures  are  promptly  taken  to  secure, 
as  far  as  necessary,  the  vaccination  (or,  as  the  case  may  be,  re- 
vaccination)  of  all  such  persons  as  are  especially  exposed  to  the 
danger  of  the  infection. 

Under  the  Order  of  Privy  Council  of  February  18,  1868  (Eeg. 
I.  Art.  1),  the  public  vaccinator  is  authorised  to  vaccinate,  elsewhere 
than  at  the  public  station,  cases  in  which  there  exists  a  special 
reason  (to  be  noted  by  him  in  his  register)  for  taking  this  excep- 
tional course  ;  and  sec.  13  of  34  and  35  Viet.  cap.  98,  provides 
that  district  medical  officers  in  attendance  upon  any  person  suffer- 
ing from  smallpox  shall  be  entitled  to  payment  from  the  Guardians 
for  vaccinating  or  (as  the  case  may  be)  re-vaccinating  any  person 
who  is  resident  in  the  same  house  as  such  sick  person,  and  who 
could  lawfully  be  vaccinated  or  (as  the  case  may  be)  re-vaccinated 
by  a  public  vaccinator  at  the  public  expense. 

These  provisions,  promptly  applied  on  the  occurrence  of  any 
isolated  case  or  cases  of  smallpox,  will  in  general  be  found  adequate 
to  stop  the  further  spread  of  the  disease  ;  but  if  from  neglect  of 
them  or  from  any  other  circumstances  cases  of  smallpox  shall  have 
become  numerous,  special  measures  (as  below  explained)  should  be 
taken  to  expedite,  as  far  as  practicable,  the  vaccination  of  all  un- 
vaccinated  persons  in  the  district,  and  to  promote  the  re- vaccination 
of  adults  and  adolescents  who  have  not  already  been  successfully 
re-vaccinated  ;  and  special  arrangements  (as  below  explained)  may 
also  be  requisite  to  facilitate  the  performance  of  public  vaccination 
and  re-vaccination. 

This  Memorandum  is  intended  to  afford  information  on  those 
measures  and  arrangements. 

I. — Special  Instructions  to  Vaccination  Officers. 
1.  At  times  when  smallpox  is  epidemic,  the  vaccination  officer 


464  APPENDIX. 

should  give  his  first  and  special  attention  to  the  particular  localities 
in  which  the  infection  exists. 

2.  In  order  that  for  this  purpose  he  may  have  the  earliest  pos- 
sible information  of  the  occurrence   of  cases  of  the   disease,  the 
Guardians  should  instruct  their  district  medical  officers  to  give  him 
immediate  notice   of  every  fresh   case   of  smallpox  which  comes 
under  their  treatment,  and  should  also  arrange  with  the  registrars  of 
deaths  to  forward  to  him  immediate  notice  of  each  death  registered 
from    smallpox.      For  convenience   of  transmitting    such<  notices, 
each  district  medical  officer  and  Registrar  should  be  supplied  with 
forms  duly  stamped  for  post,  or  with  post-cards  adapted  for  the 
purpose.     Private  medical  practitioners  should  also  be  invited  to 
give  similar  information. 

3.  In  each  locality  in  which  the  infection  exists,  the  vaccination 
officer  should  with  the  utmost  possible  despatch  personally  ascertain 
what  children  are  unprotected  by  vaccination,  and  should  use  his 
utmost  exertions  to  obtain  the  prompt  vaccination  of   all   such 
children.     Generally  speaking,  his  own  judgment  and  local  know- 
ledge will  guide  him  as  to  the  manner  in  which  his  inquiries  can 
best  be  made  ;  but  in  infected  courts  or  alleys,  as  well  as  certain 
kinds  of  streets,  inquiries  from  house  to  house,  and  in  tenement- 
houses  from  room  to  room,  will  be  indispensable. 

4.  Where  any  child  (between  the  ages  of  3  months  and  14 
years)  is  found  illegally  unvaccinated,  the  vaccination  officer  should 
give  a  notice  requiring  the  vaccination  to  be  done  within  a  specified 
period.     This  period,  when  there  is  smallpox  in  the  house,  or  other 
special  risk  of  exposure  to  the  contagion,  should  not  exceed  twenty- 
four  hours  ;  but  in  other  cases  some  days,  not  exceeding  a  week, 
may  be  allowed.     A  second  visit  from  the  vaccination  officer  will, 
of  course,  afterwards  be  necessary  in  order  to  see  that  his  notice  has 
been  complied  with. 

With  regard  to  unvaccinated  children  not  yet  three  months  old, 
who  may  be  in  infected  localities,  the  vaccination  officer  should 
advise  the  parents  not  to  incur  the  unnecessary  risk  of  waiting  for 
the  child  to  complete  that  age  before  having  its  vaccination  per- 
formed ;  for  vaccination  is  perfectly  well  borne  by  children  even 
immediately  after  birth.  In  no  house  in  which  there  is  smallpox 
ought  a  child,  however  young,  on  any  account  to  remain  unvacci- 
nated, unless  on  medical  examination  it  be  pronounced  unfit  to  be 
vaccinated. 

5.  The  vaccination  officer  should  make  it  well  known  in  infected 
localities  that  the  public  vaccinator  is  at  liberty  to  re-vaccinate 
grown-up  and  young  persons  (not  under  12  years  of  age)  who  have 
not  before  been  successfully  re- vaccinated,  and  who  apply  to  him 


APPENDIX.  465 

for  that  purpose  ;  and  that  persons  not  vaccinated  since  childhood, 
who  are  likely  to  be  exposed  to  contagion,  ought  to  be  re- vaccinated 
without  delay.  Above  all,  this  is  necessary  for  persons  whose" 
original  marks  of  vaccination  are  imperfect 

6.  All  notices  given  and  representations  made  as  above  should 
be  accompanied  with  information  as  to  the  provisions  made  for 
public  vaccination  in  the  district.     If  any  case  requiring  prompt 
vaccination  by  the  public  vaccinator  cannot,  in  the  judgment  of  the 
vaccination  officer,  properly  be  taken  to  the  station  or  to  the  resi- 
dence of  the  public  vaccinator,  the  vaccination  officer  should  give  to 
the  public  vaccinator  immediate  information  of  the  case. 

7.  Besides  the  above-described  special  proceedings  in  localities 
already  infected,  the  vaccination  officer  should  take  every  means  to 
ensure  that  the  vaccination  of  his  district  generally  is  as  complete 
M  possible.     He  should  make  frequent  examination  of  his  birth- 
lists,  and  deal,  as   soon  as  practicable,  with  every  default  as  it 
arises  ;  and  he  should    be  prompt  and  diligent  in  his  inquiries 
respecting  the  other  children  to  whom  his  duties  extend  under 
section  1 2  of  his  "  instructions,"  as  issued  by  the  Local  Government 
Board. 

ill. — Special  Arrangements  for  Public  Vaccination. 

1.  In  towns  which  have  regular  weekly  attendances  for  the  per- 
formance of  public  vaccination,  the  only  modification  usually  requi- 
site will  consist  in  the  vaccinator.s  giving  special  daily  attendances 
at  the  stilt  ion  at  a  fixed  hour  for  the  vaccination  of  cases  of  emer- 
gency. 

[\Vln-iv  the  town-district  is  of  particularly  large  population  (so 
that  the  ordinary  average  weekly  number  of  primary  vaccinations 
performed  at  the  stations  exceeds  twenty),  it  may  be  convenient 
that  during  tin-  stress  of  the  epidemic  the  station  should  be  open  for 
the  general  performance  of  vaccination  on  two  days  (instead  of  one 
day)  in  each  week.] 

It  must,  however,  be  distinctly  under.-tood  that  the  daily  att«-n«l- 

-  given  as  above  are  only  for  cases  of  emergency;  and  that  « 
which  are  not  of  emergency  must  be  left  to  the  times  of  general 
vaccination. 

It  is  on  the  regular  weekly  attendance.-  that  tin-  vaccinator  has 
to  depend  not  only  to  maintain  the.  u.-ual  performance  <>f  primary 

vaccination  from  arm  to  arm,  hut  also  to  furnish  lymph  f'»r  C8 
re-vaccination  and  !'<•]•  use  in  his  special  attendances  ;  -md  the  expe- 
rience of   every  recent    epidemic   of   .smallpox   ha-   shown    that  to 
attempt  at  such  times  an  indiscriminate   dailv  performance  of  vac- 

'1   II 


466  APPENDIX. 

cination  and  re-vaccination  leads  only  to  difficulties  and  disadvan- 
tages. There  are  two  reasons,  indeed,  for  which  at  such  times  an 
adherence  to  systematic  arrangements  (with  exception  only  for 
special  cases)  is  of  more  than  ordinary  consequence  ;  first,  because 
it  is  then  peculiarly  important  that  each  primary  vaccination 
should  be  done  under  conditions  which  scarcely  admit  of  failure  ; 
and  secondly,  because  without  system  it  is  quite  impossible  pro- 
perly to  meet  the  large  demands  for  re-vaccination  which  at  such 
times  are  sure  to  arise.  Re-vaccinations,  unless  of  persons  residing 
in  houses  in  which  there  is  smallpox,  or  under  other  exceptional 
circumstances,  should  always  be  reserved  for  the  regular  vaccination 


2.  In  districts  (whether  of  town  or  country)  which  ordinarily 
have  their  public  vaccinations  performed  at  quarterly  or  half-yearly 
or  other  intervals,  should  smallpox  break  out  at  a  time  of  year 
when  vaccination  is  not  going  on,  it  will  be  necessary  that  the  station 
for  the  district,  or  part  of  district,  in  which  the  disease  is  prevailing 
should  at  once  be  open,  and  that  a  weekly  attendance  should  be 
given  thereat  for  a  limited  period  ;  during  which  period  the  vaccina- 
tion officer  should  take  steps  as  above  directed  for  making  the 
vaccination  of  the  district,  or  part  of  district,  as  complete  as  possible. 
In  districts  of  the  kind  now  under  consideration  it  will  probably  be 
more  convenient  that  cases  of  emergency  should  be  vaccinated  at 
their  own  homes  under  the  exceptional  provisions  of  Regulation  1, 
Article  1,  of  the  Order  of  Feb.  18,  1868  (above  referred  to)  than 
that  daily  attendances  should  be  given  at  the  station. 

3.  Any  exceptional  vaccination  arrangements  made  as  above  by 
the  guardians  with  reference  to  epidemics  of  smallpox  should  be 
for  some  fixed  period,  not  exceeding  six  weeks  ;  at  the  end  of 
which  period  they  can,  in  case  of  need,  be  renewed  by  a  further 
order  of  the  guardians  ;  but  every  such  making  or  renewal  of  the 
exceptional  arrangements  should  be  reported  without  delay  to  the 
Local  Government  Board. 

N.B. — The  isolation  of  the  sick,  the  disinfection  of  infected 
houses,  and  the  disinfection  or  destruction  of  infected  things,  are 
very  important  means  of  checking  the  spread  of  smallpox  ;  and  in 
order  that  such  measures  may  be  enforced,  the  Public  Health  Act, 
1875,  besides  imposing  penalties  011  the  exposure  of  infected  persons, 
the  letting  of  infected  houses,  the  sale  of  infected  things,  and  other 
acts  similarly  dangerous  to  the  public  health,  gives  very  important 
powers  to  sanitary  authorities.  These  are  stated  in  the  official 
"  Memorandum  on  the  duties  of  sanitary  authorities  in  reference  to 
epidemics  of  smallpox."  It  is  also  to  be  observed  that,  so  far  as 
the  destitute  classes  are  visited  by  smallpox,  boards  of  guardians, 


APPENDIX.  467 

as  poor  law  authorities,  have  opportunities,  which  it  is  desirable 
they  should  fully  use,  for  securing  disinfection  and  the  isolation  of 
the  sick. 


VI. — MEMORANDUM  for  the  Assistance  of  GUARDIANS  and 
others  in  framing  and  carrying  out  Arrangements  for 
the  Performance  of  PUBLIC  VACCINATION. 

PUBLIC  VACCINATION. 

Vaccination  Acts,  1867  and  1871. 
Regulations  of  1st  December  1859,  and 
Regulations  of  1 8th  February  1868. 

1.  In  order  to  secure  the  best  sort  of  vaccination,  the  operation 
should,  as  far  as  practicable,  be  performed  with  fresh  lymph  direct 
from  arm  to  arm.     The  lymph  should  be  carefully  selected  from 
the  best-formed  vesicles  upon  the  healthiest  children  at  the  right 
period  of  the  course  of  the  vesicles.     And  the  arrangements  for 
public  vaccination  under   the  vaccination  contracts  ought  to   be 
framed  so  as  to  secure,  as  far  as  possible,  these  objects. 

2.  As,  in  ordinary  circumstances,  it  is  at  the  end  of  the  week 
from  vaccination  that  the  arm  of  a  child  is  in  the  state  best  fitted 
for  yielding  lymph,  the  attendances  for  the  performance  of  public 
vaccination  must  be  given  at  weekly  intervals. 

3.  As,  for  keeping  up  vaccination  in  perfection,  it  is  essential 
that  a  public  vaccinator  should  have  on  each  vaccinating  occasion  a 
large  choice  of  children  and  of  vesicles,  it  is  obvious  that  the  cases 
for  vaccination  must  not  be  divided  between  too  many  stations,  or 
distributed  over  too  many  vaccinating  days.    • 

4.  It  is  only  in  very  populous  districts  that  weekly  vaccination 
can  be  maintained  efficiently  throughout  the  year.     If  an  attempt 
were  made  to  keep  up  vaccination  throughout  the  year  at  a  vac- 
cination station  to  which  (say)  100  cases  are  brought  annually,  it 
would  be  found  that  as  the  births  are  not  equally  spread  over  the 
whole  year,  and  as  accidental  circumstances  must  often  interfere 
with  the  bringing  of  children  in  particular  weeks,  there  would  not 
unfrequently  be  no  cases  at  all  at  the  station  to  supply  lymph,  and 
in  the  majority  of  weeks  not  a  sufficient  number  of  children  to  en- 
able the  vaccinator  to  make  a  proper  selection. 

5.  Hence,   in  districts    which    are    not    very  populous,    it  is 
necessary  that  public  vaccination  should  be  performed  at  certain 
periods  of  the  year,  as  at  quarterly  or  half-yearly  periods,  weekly 


468  APPENDIX. 

attendances  being  then  given  for  two,  three,  four,  or  more  successive 
weeks,  according  to  the  population  for  the  accommodation  of  which 
the  particular  station  is  designed. 

6.  Without  attempting  to  lay  down  a  precise  rule  011  a  question 
which  must  largely  be  decided  according  to  the  circumstances  of 
each  locality,  it  may  be  said,  generally,  that  any  station  at  which 
there  are  less  than  80  vaccinations  annually  should  not  be  attended 
more  frequently  than  at  half-yearly  periods. 

7.  Provision  is  made  by  the  12th  section  of  the  Vaccination 
Act,  1867,  by  which,  in  districts  in  which  public  vaccination  is 
performed  at  intervals  exceeding  three  months,  parents  of  children 
attaining  the  age  of  three  months  do  not  become  liable  to  penalty 
for  the  non-vaccination  of  their  children  until  after  the  next  public 
vaccination  held  in  the  district  subsequently  to  their  having  at- 
tained that  age. 

8.  Children  living  within  two  miles  of  a  vaccination  station 
cannot  (unless  under  special  circumstances)  legally  be  vaccinated  by 
the  public  vaccinator  except  at  the  station  and  at  the  time  specified 
in  the  contract.     If,  however,  some  special  reason  require  this  rule 
to  be  departed  from  in  any  particular  case,  an  entry  stating  the 
"special  reason"  must,  in  accordance  with  the  Regulations  of  18th 
February  1868,  be  made  in  the  vaccinator's  register. 

9.  Having  regard  to  weather  and  to  other  considerations,  the 
months  of  April  and  October  will  generally  be  found  most  suitable 
for  half-yearly  vaccination. 

10.  In  framing  periodical  arrangements  for  districts  in  which 
there  are  two  or  more  stations,  the  attendances  should  not  commence 
in  the  same  week  at  all  the  stations,  but  a  week  or  two  should  be 
given  for  establishing  at  the  most  frequented  station  a  supply  of 
lymph  with  which  to  start  vaccination  at  the  others. 

11.  It  is  convenient  that,  as  far  as  practicable,  the  stations  of  a 
district  should  be  attended  on  the  same  week  day,  in  order  that, 
when  necessary,  lymph  may  be  taken  fresh  from  station  to  station. 

12.  In  districts  in  which  public  vaccination  is  fixed  to  take 
place  periodically,  the  public  vaccinator  should,  on  the  day  week 
preceding  the  first  day  of  the  periodical  attendances  appointed  under 
Schedule  A  to  the  contract,  vaccinate  with  lymph  stored  by  himself 
or  obtained  from  the  National  Vaccine  Establishment,  or  some  other 
trustworthy  source,  two  or  three  selected  children.     Arrangements 
should  be  made  for  bringing  these  children  to  the  station  on  the 
day  appointed  for  beginning  the  periodical  vaccination  of  the  dis- 
trict, and  the  lymph  from  their  arms  will  afford  means  of  starting 
such  vaccination  satisfactorily.     The  public  vaccinator  in  registering 
these  vaccinations  should,  in  accordance  with  Regulation  1  of  18th 


APPENDIX.  469 

February  1868,  state  in  his  register  the  special  reason  for  their  not 
having  been  vaccinated  at  the  station. 

13.  By  section  7  of  the  Vaccination  Act,  1867,  it  is  provided 
that  all  vaccination  stations  (except  at  the  residence  or  surgery  of 
the  public  vaccinator)  shall  be  provided  by  the  guardians. 

1 4.  Vaccination  stations  must  be  within  the  district  for  which 
they  are  to  serve,  and  must  not  be  fixed  at  union  workhouses,  as  the 
independent  poor  are  unwilling  to  resort  for  vaccination  to  an  insti- 
tution connected  with  pauper  relief.     The  same  objection  applies, 
though  perhaps  in  a  minor  degree,  to  the  appointment  of  pauper 
pay  stations  as  vaccination  stations.     The  Board  further  consider 
it  undesirable  that  public-houses  should  be  selected  for  the  purpose. 
Whatever  room  or  place  be  selected  as  a  vaccination  station,  it  is 
essential  that  the  public  vaccinator  should  have  the  exclusive  use 
of  it  during  the  time  of  vaccination. 

1 5.  In  large  towns  the  vaccination  station  should,  if  possible,  be 
at  some  public  building,  e.g.  town  hall,  meeting  hall,  or  school,  or 
at  rooms  specially  hired  for  the  purpose.     Various  objections  exist 
to  the  use  of  the  surgeries  of  public  vaccinators  in  such  towns, 
especially  that  they  rarely  afford  the  accommodation  necessary  for 
the  number  of  children  likely  to  be  brought,  and  that  they  do  not 
possess  the  distinctive  public  character  which  is  desirable. 

16.  In  rural  districts    schoolrooms  are  frequently  found  con- 
venient for  the  purpose.     It  is  of  course  necessary  that  the  assent 
of  the  managers  of  the  school  should  be  obtained  ;  that  the  vaccina- 
tion should  be  fixed  at  such  an  hour  as  not  to  interfere  with  school 
arrangements  ;  and  particularly  that  the  public  vaccinator  should 
have  at  the   time  fixed  for  vaccination  the   exclusive  use   of  the 
schoolroom  or  class-room  appointed  for  the  purpose. 

17.  In  order  to   secure   at  vaccination   stations  the  punctual 
1  Tinging  together  of  children  (from  some  of  whom  lymph  has  to 
be  taken  for  the  vaccination  of  others),  it  is  desirable  that  the  time 
of  attendance  notified  to  parents  should  be  that  at  which  vaccina- 
tion is  intended   to  begin,  as  "at   10  A.M.,"  not  "from  10  to  11 
A.M. 

18.  The  hour  of  public  vaccination  should  never  be  fixed  so 
late  in  the  day  as  to  make  it  impracticable  to  complete  the  business 
of  the  station  by  daylight. 

19.  Enough  time  (which  should  rarely  be  less  than  one  hour) 
should  be  allowed   between  the  times  of    attendance  at   different 
stations  to  enable  the  public  vaccinator,  after  performing  vaccina- 
tion and  making  the  necessary  entries  in  the  register  at  one  station, 
to  arrive  punctually  at  the  next. 

20.  The  payments  to  be  made  for  vaccinations  performed  at 


470  APPENDIX. 

other  places  than  stations  should  not  in  any  case  exceed  the  sum 
that  would  have  been  paid  had  the  operation  been  performed  at 
the  station  nearest  to  the  residence  of  the  person  vaccinated. 

21.  Every  vaccination  contract  must  contain  a  stipulation  or 
condition  in  accordance  with  section  7  of  the  Vaccination  Act, 
1867.  The  form  in  general  use  is  as  follows  : — 


And  it  is  hereby  mutually  agreed  by  and  between  the  parties 
hereto,  that  no  money  shall  be  paid  to  the  said 

in  respect  of  any  person  vaccinated  by  him  until  he  shall 
have  transmitted  to  the  vaccination  officer  a  certificate  of  the  suc- 
cessful vaccination  of  such  person,  and  otherwise  fulfilled  on  his 
part  the  requirements  of  the  Vaccination  Acts,  1867  and  1871,  and 
the  regulations  made  thereunder. 

22.  The  course  to  be  taken  if  smallpox  break  out  in  a  district 
where  ordinarily  the  public  vaccination  is  carried  on  periodically,  is 
explained  in  the  Office  Memorandum  on  the  steps  to  be  taken  by 
guardians  in  places  in  which  smallpox  is  epidemic. 

23.  If  an    infectious   disease,    such  as   scarlatina,  measles,   or 
diphtheria,  prevail  to  such  an  extent  in  a  district  that  the  public 
vaccinator  considers  that  the  bringing  of  children  together  for  vac- 
cination would  be  likely  to  spread  the  disease,  he  should  represent 
the  facts  to  the  guardians  for  communication  with  the  Board,  who 
will,  on  sufficient  cause  shown,  be  ready  to  authorise  the  postpone- 
ment of  the  attendances  prescribed  by  the  contract. 

24.  A  contractor  for  public  vaccination  must  be  a  registered 
medical   practitioner  qualified  in   medicine  and  surgery,   and  (if 
admitted  to  practice  since  1st  January  1860)  possessing  a  special 
certificate  of  proficiency  in  vaccination  from  one  of  the  Examiners 
authorised  to  grant  such  certificates  for  the  purposes  of  the  order  of 
1st  December  1859. 

25.  The  duties  of  a  public  vaccinator  must  be  habitually  dis- 
charged by  the  contractor  himself,  and  the  employment  of  a  deputy 
must  be  limited  to  those  occasions  when  unavoidable  circumstances 
prevent  the  contractor's  personal  attendance. 

26.  In  order  to  provide  for  occasions  when  the  public  vaccinator 
is  unavoidably  absent,  it  is  proper  that  a  deputy  (who  must  possess 
the  same  qualifications  as  a  contractor)  should  be  appointed  under 
the  Regulations  of  1st  December  1859,  and  that  the  appointment, 
after   being  submitted  by  the  guardians  for  the  approval  of  ^the 
Local  Government  Board,  should  be  endorsed  upon  the  contract. 
It  must  be  understood,  however,  that  the  approval  of  such  appoint- 


APPENDIX.  471 

ment  is  not  to  be  taken  as  authorising  any  habitual  omission  on  the 
part  of  the  public  vaccinator  to  perform  in  person  the  duties  for 
which  he  is  responsible. 

27.  Public  vaccination  cannot,  under  any  circumstances,  be 
legally  performed  by  an  unqualified  person,  and  the  guardians  can- 
not legally  pay  for  any  vaccination  so  performed. 


VII. — RE- VACCINATION. 

By  vaccination  in  infancy,  if  thoroughly  well  performed  and 
successful,  most  people  are  completely  insured  for  their  whole  life- 
time against  an  attack  of  smallpox  ;  and  in  the  proportionately 
few  cases  where  the  protection  is  less  complete,  smallpox,  if  it  be 
caught,  will,  in  consequence  of  the  vaccination,  generally  be  so  mild 
a  disease  as  not  to  threaten  death  or  disfigurement.  If,  however, 
the  vaccination  in  early  life  have  been  but  imperfectly  performed, 
or  have  from  any  other  cause  been  but  imperfectly  successful,  the 
protection  against  smallpox  is  much  less  satisfactory  ;  neither  last- 
ing so  long,  nor,  while  it  lasts,  being  nearly  so  complete  as  the 
protection  which  first-rate  vaccination  gives.  In  consequence  of 
the  large  amount  of  imperfect  vaccination  which  has  till  very  recent 
years  existed,  the  population  contains  very  many  persons  who, 
though  nominally  vaccinated,  and  believing  themselves  to  be  pro- 
tected against  smallpox,  are  really  liable  to  infection,  and  may,  in 
some  cases,  contract  as  severe  forms  of  smallpox  as  if  they  had 
never  been  vaccinated.  Partly  because  of  the  existence  of  this 
large  number  of  imperfectly  vaccinated  persons,  and  partly  because 
also  even  the  best  infantine  vaccination  sometimes  in  process  of 
time  loses  more  or  less  of  its  effect,  it  is  advisable  that  all  persons 
who  have  been  vaccinated  in  infancy  should)  as  they  approach  adult 
life,  undergo  RE-VACCINATION.  Generally  speaking,  the  best  time  of 
life  for  re-vaccination  is  about  the  time  when  growth  is  completing 
itself,  say  from  15  to  18  years  of  age  ;  and  persons  in  that  period 
of  life  ought  not  to  delay  their  re-vaccination  till  times  when  there 
shall  be  special  alarm  of  smallpox  :  first,  because  they  can  never 
tell  how  soon,  or  by  what  chance,  they  may  (even  at  times  when 
there  is  little  prevalence  of  that  disease)  be  exposed  to  its  infection  ; 
and  secondly,  because  of  the  much  more  advantageous  conditions 
under  which  the  re-vaccination  can  be  performed  when  it  can  be 
done  leisurely,  than  when  it  has  to  be  done  under  the  pressure 
caused  by  a  panic.  When,  however,  smallpox  becomes  epidemic, 
not  only  should  all  persons  above  15  years  of  age  who  had  hitherto 
neglected  to  have  themselves  re -vaccinated  be  very  careful  to 


472  APPENDIX. 

neglect  it  no  longer,  but  in  proportion  as  there  is  prevalence  of 
smallpox  in  any  neighbourhood,  or  as  individuals  are  from  per- 
sonal circumstances  likely  to  meet  chances  of  infection,  even  the 
age  of  1 5  should  not  be  waited  for,  especially  not  by  young  persons 
whose  marks  of  previous  vaccination  are  unsatisfactory.  The  rule 
applicable  to  circumstances  of  special  danger  is  this  :  that  every  one 
past  childhood  on  whom  re-vaccination  has  not  before  been  successfully 
performed,  should  without  delay  be  re-vaccinated. 

Ke-vaccination,  once  properly  and  successfully  performed,  does 
not  appear  ever  to  require  repetition.  The  nurses  and  other  servants 
of  the  London  Smallpox  Hospital,  when  they  enter  the  service 
(unless  it  be  certain  that  they  have  already  had  smallpox),  are 
invariably  submitted  to  vaccination,  which  in  their  case  generally 
is  re-vaccination,  and  is  never  afterwards  repeated  ;  and  so  perfect 
is  the  protection  that,  though  the  nurses  live  in  the  closest  and  most 
constant  attendance  on  smallpox  patients,  and  though  also  the 
other  servants  are  in  various  ways  exposed  to  special  chances  of  in- 
fection, the  resident  surgeon  of  the  hospital,  during  his  forty-one 
years  of  office  there,  has  never  known  smallpox  affect  any  one  of 
these  nurses  or  servants. 

Legal  provisions  for  re-vaccination  are  made  in  the  8th  Section 
of  the  Vaccination  Act,  1867,  in  Section  IV.  of  the  Regulations 
which  the  Lords  of  the  Council,  under  authority  of  that  Act,  issued 
in  their  order  of  February  18,  1868,  and  in  the  9th  Section  of 
the  Vaccination  Act,  1871.  Under  these  provisions,  Re-vaccination 
is  now  performed  by  all  public  vaccinators  at  their  respective  vaccinat- 
ing stations ;  and,  so  far  as  is  not  inconsistent  with  the  more  im- 
perative claims  for  primary  vaccination,  any  person  coming  within 
the  terms  of  these  provisions  may,  on  applying  to  the  public  station  of 
the  district  in  which  he  resides,  obtain  re-vaccination  free  of  personal 
cost. 

EDWARD  C.  SEATON,  M.D. 
Medical  Officer. 

Local  Government  Board,  October  17,  1876. 


VIII. — MEMORANDUM  issued  by  the  NATIONAL  VACCINE 
ESTABLISHMENT  with  SUPPLIES  of  CALF-LYMPH. 

CALF-LYMPH  VACCINATION. 
The  present  lymph  is  sent  for  the  commencement  of  a  local 


APPENDIX.  473 

series  of  ami-to-arm  vaccinations.     In  using  it  for  this  purpose,  it 
is  to  be  remembered — 

(1.)   That,  as  compared  with  humanised  lymph,  calf-lymph  is  much 

less  easy  of  removal  from  the  "points;" 
(2.)  That  such  lymph  does  not  "take"  with  the  same  degree  of 

certainty  as  humanised  lymph  ; 
(3.)  That  the  course  of  the  early  vaccinations  of  a  series  is  not  so 

regular  as  with  humanised  lymph. 

Any  child  chosen  for  vaccination  with  the  lymph  now  sent 
should  be  between  three  and  five  months  old,  and  should  be 
selected  for  its  own  good  health  and  for  the  known  good  health  of 
its  parents.  Two  large  points  are  needed  for  the  vaccination  of  a 
single  child.  The  lymph  on  them  should  be  moistened  for  a 
minute  with  water,  and  should  then  be  thoroughly  rubbed  into 
each  of  four  or  five  places  prepared  on  the  child's  arm  or  arms. 
Each  of  these  places  should  be  made  by  abrasion  with  a  blunt 
lancet  over  an  area  of  an  eighth  of  an  inch  square. 

In  vaccinating  subsequent  children,  lymph  should  be  taken 
from  fully -developed  vesicles  before  the  formation  of  an  areola 
round  them.  The  vaccination  of  the  first  child  is  liable  to  be 
retarded,  and  that  of  the  next  few  children  is  frequently  acceler- 
ated ;  so  that  it  is  desirable  to  inspect  the  several  vaccinifers  on 
other  days  beside  the  day-week,  in  order  that  the  best  time  for 
taking  lymph  may  be  assured. 


Calf-lymph  for  the  vaccination  of  children  is  best  preserved  on 
points  ;  but  if  it  is  desired  to  establish  local  series  of  calf-to-calf 
vaccinations,  lymph  in  tubes  or  between  glasses  is  to  be  preferred. 
Special  application  to  the  National  Vaccine  Establishment  should 
be  made  if  lymph  stored  in  either  of  the  latter  ways  is  desired. 
One  or  more  perfectly  healthy  calves  of  four  to  five  months  old 
should  be  in  readiness  at  the  time  of  making  the  application. 

August  1881. 


IX. — GENERAL  MEMORANDUM  on  the  PROCEEDINGS  which 
are  advisable  in  PLACES  attacked  or  threatened  by 
EPIDEMIC  DISEASE. 

1 .  Wherever  there  is  prevalence  or  threatening  of  cholera,  diph- 
tlit-i'ia,   I't-vrr,  or  any   other  epidemic  disease,  it  is  of  more  than 


474  APPENDIX. 

common  importance  that  the  statutory  powers  conferred  upon  sani- 
tary authorities  for  the  protection  of  the  public  health  should  be 
well  exercised  by  those  authorities,  acting  with  the  advice  of  their 
medical  officers  of  health. 

2.  Proper  precautions  are  equally  requisite  for  all  classes  of 
society.     But  it  is  chiefly  with  regard  to  the  poorer  population, 
therefore   chiefly  in  the   courts  and  alleys  of  towns,  and  at  the 
labourers'  cottages  of  country  districts,  that  local  authorities  are 
called  upon  to  exercise  vigilance,  and  to  proffer  information  and 
advice.     Common  lodging-houses,  and  houses  which  are  sub-let  in 
several  small  holdings,  always  require  particular  attention. 

3.  Wherever  there  is  accumulation,  stink,  or  soakage  of  house 
refuse,  or  of  other  decaying  animal  or  vegetable  matter,  the  nuisance 
should  as  promptly  as  possible  be  abated,  and  precaution  should  be 
taken  not  to  let  it  recur.     Especially  examination  should  be  made 

/  as  to  the  efficient  working  of  sewers  and  drains,  and  any  nuisance 
therefrom,  or  from  any  foul  ditches  or  ponds,  should  be  got  rid  of 
*  *(_^  without  delay.  The  ventilation  of  sewers,  the  ventilation  and  trap- 
ping of  house  drains,  and  the  disconnection  of  cistern  overflows  and 
sink  pipes  from  drains,  should  be  carefully  seen  to.  The  scavenging 
of  the  district,  the  state  of  receptacles  for  excrement,  and  of  dust- 
bins, will  require  particular  and  sustained  attention.  In  slaughter- 
houses, and  wherever  animals  are  kept,  strict  cleanliness  should  be 
enforced. 

4.  In  order  to  guard  against  the  harm  which  sometimes  arises 
from  disturbing  heaps  of  offensive  matter,  it  is  often  necessary  to 
combine  the  use  of  chemical  disinfectants  (see  §  1 7)  with  such  means 
as  are  taken  for  the  removal  of  filth  ;  and  in  cases  where  removal 
is  for  the  time  impossible  or  inexpedient,  the  filth  should  always  be 
disinfected.     Disinfection  is  likewise  desirable  for  unpaved  earth 
close  to  dwellings,  if  it  be  sodden  with  slops  and  filth.     Generally, 
where  cholera  or  enteric  (typhoid)  fever  is  in  a  house,  the  privy 
requires  to  be  disinfected. 

5.  Sources  of  water-supply  should  be  well  examined.     Those 
^  /4       which  are  in  any  way  tainted  by  animal  or  vegetable  refuse,  above 

all,  those  into  which  there  is  any  leakage  or  filtration  from  sewers, 
•  -'»    drains,  cesspools,  or  foul  ditches,  ought  no  longer  to  be  drunk  from. 
"344  JC/~  Especially  where  the  disease  is  cholera,  diarrhosa,  or  enteric  fever, 
ffa  it  is  essential  that  no  foul  water  be  drunk. 

If  unfortunately  the  only  water  which  for  a  time  can  be  got 
•'/'fcju  should  be  open  to  suspicion  of  dangerous  organic  impurity,  it  ought 
at  least  to  be  boilecl  before  it  is  used  for  drinking,  but  then  not  to 
be  drunk  later  than  twenty-four  hours  after  it  has  been  boiled.     Or 
uncier  medical  or  other  skilled  direction,  water,  in  quantities  suffi- 


APPENDIX.  475 

cient  for  one  day's  drinking  in  the  house,  may  be  disinfected  by  a 
very  careful  use  of  Cond/s  red  disinfectant  fluid  ;  which  should  be 
added  to  the  water  (with  stirring  or  shaking)  in  such  number  of 
drops  that  the  water,  an  hour  afterwards,  shall  have  the  faintest 
pink  colour  which  the  eye  can  distinctly  perceive.  Filtering  of  the 
ordinary  kind  cannot  by  itself  be  trusted  to  purify  water,  but  is  a 
good  addition  to  either  of  the  above  processes.  It  cannot  be  too 
distinctly  understood  that  dangerous  qualities  of  water  are  not  ob- 
viated by  the  addition  of  wine  or  spirits. 

When  there  appears  any  probable  relation  between  the  distribu- 
tion of  disease  and  of  milk  supplies,  the  cleanliness  of  dairies,  and 
the  purity  of  the  water  used  in  them,  should  be  carefully  investi- 
gated. 

6.  The  washing  and  lime-whiting  of  uncleanly  premises,  especi- 
ally of  such  as  are  densely  occupied,  should  be  pressed  with  all 
practicable  despatch. 

7.  Overcrowding  should  be  prevented.     Especially  where  disease  j 
has  begun,  the  sick-room  should,  as  far  as  possible,  be  free  from( 
persons  who  are  not  of  use  or  comfort  to  the  patient.  J 

8.  Ample  ventilation  should  be  enforced.     It  should  be  seen 
that  window -frames  are  made  to  open,  and  that  windows  are  suffi- 
ciently opened.     Especially  where  any  kind  of  infective  fever  has 
begun,  it  is  essential,  both  for  patients  and  for  persons  who  are 
about  them,  that  the  sick-room  and  the  sick -house  be  constantly 
well  traversed  by  streams  of  fresh  air. 

9.  The  cleanliest  domestic  habits  should  be  enjoined.     Refuse 
matters  which  have  to  be  cast  away  should  never  be  allowed  to 
remain  within  doors ;  and  things  which  have  to  be  disinfected  or 
cleansed  should  always  be  disinfected  or  cleansed  without  delay. 

10.  Special  precautions  of  cleanliness  and  disinfection  are  neces- 
sary with  regard  to  infective  matters  discharged  from  the  bodies  of 
the  sick.     Among  discharges  which  it  is  proper  to  treat  as  infective, 
are  those  which  come,  in  cases  of  smallpox,  from  the  affected  skin  ; 
in  cases  of  cholera  and  enteric  fever,  from  the  intestinal  canal ;  in 
cases  of  diphtheria,  from  the  nose  and  throat  ;  likewise,  in  cases  of 
any  eruptive  or  other  epidemic  fever,  the  general  exhalations  of  the 
sick.     The  caution  which  is  necessary  with  regard  to  such  matters 
must,  of  course,  extend  to  whatever  is  imbued  with  them  ;  so  that 
bedding,  clothing,  towels,  and  other  articles,  which  have  been  in 
use  by  the  sick,  may  not  become  sources  of  mischief,  either  in  the 
house  to  which  they  belong  or  in  houses  to  which  they  are  conveyed. 
Moreover,  in  enteric  fever  and  cholera,  the  evacuations  should  be 
regarded  as  capable  of  communicating  an  infectious  quality  to  any 
night-soil  with  which  they  are  mingled  in  privies,  drains,  or  cess- 


4*76  APPENDIX. 

pools  ;  .and  this  danger  is  best  guarded  against  by  thoroughly  dis- 
infecting them  before  they  are  thrown  away  (see  §  17) ;  above  all, 
they  must  never  be  cast  where  they  can  run  or  soak  into  sources  of 
drinking  water. 

11.  All  reasonable  care  should  be  taken  not  to  allow  infective 
disease  to  spread  by  the  unnecessary  association  of  sick  with  healthy 
persons.     This  care  is  requisite,  not  only  with  regard  to  the  sick- 
house,  but  likewise  with  regard  to  day  schools  and  other  establish- 
ments wherein  members  of  many  different  households  are  accustomed 
to  meet. 

12.  "Where  dangerous  conditions  of  residence  cannot  be  promptly 
remedied,  it  will  be  best  that  the  inmates,  while  unattacked  by  dis- 
ease, remove  to  some  safer  lodging.     If  disease  begins  in  houses 
where  the  sick  person  cannot  be  rightly  circumstanced  and  tended, 
medical  advice  should  be  taken  as  to  the  propriety  of  removing  him 
to  an  infirmary  or  hospital.     Every  sanitary  authority  should  have 
in  readiness  a  hospital  for  the  reception  of  such  cases. 

13.  Privation,  as  predisposing  to  disease,  may  require  special 
measures  of  relief. 

14.  In  certain  cases  special  medical  arrangements  are  necessary. 
For  instance,  as  cholera  in  this  country  almost  always  begins  some- 
what gradually  in  the  comparatively  tractable  form  of  what  is  called 
"  premonitory  diarrhoea,"  it  is  essential  that,  where  cholera  is  epi- 
demic, arrangements  should  be  made  for  affording  medical  relief 
without  delay  to  persons  attacked,  even  slightly,  with  looseness  of 
bowels.     So  again,  where  smallpox  is  the  prevailing  disease,  it  is 
essential  that  all  unvaccinated  persons  (unless  they  previously  have 
had  smallpox)  should  very  promptly  be  vaccinated  ;  and  that  re- 
vaccination  should  be  performed  in  cases  properly  requiring  it. 

15.  It  is  always  to  be  desired  that  the  people  should,  as  far  as 
possible,  know  what  real  precautions  they  can  take  against  the  dis- 
ease which  threatens  them,  what  vigilance  is  needful  with  regard  to 
its  early  symptoms,  and  what  (if  any)  special  arrangements  have 
been  made  for  giving  medical  assistance  within  the  district.     For 
the  purpose  of  such  information  printed  hand-bills  or  placards  may 
usefully  be  employed,  and  in  cases  where  danger  is  great,  house-to- 
house  visitation  by  discreet  and  competent  persons  may  be  of  the 
utmost  service,  both  in  quieting  unreasonable  alarm,  and  in  leading 
or  assisting  the  less  educated  and  the  destitute  parts  of  the  popula- 
tion to  do  what  is  needful  for  safety. 

16.  The  present  memorandum  relates  to  cases  of  emergency. 
Therefore  the  measures  suggested  in  it  are  all  of  an  extemporaneous 
kind  ;  and  permanent  provisions  for  securing  the  public  health  have 
not  been  in  express  terms  insisted  on.     It  is  to  be  remembered, 


APPENDIX.  477 

however,  that  in  proportion  as  a  district  is  habitually  well  cared 
for  by  its  sanitary  authorities,  the  more  formidable  emergencies  of 
epidemic  disease  are  not  likely  to  arise  in  it. 

1 7.  Chemical  disinfectants  are  of  two  great  classes,  and  hitherto 
it  is  not  certain  which  of  the  ^wo  classes  acts  best.  The  one  class 
is  well  represented  by  chlorine  and  certain  of  its  compounds  ;  the 
other  is  well  represented  by  carbolic  acid.  Under  the  former 
system,  the  solution  of  chloride  of  lime  may  be  used  for  minor 
domestic  purposes,  chloride  of  lime  itself  to  any  masses  of  filth,  and 
chlorine  gas  for  disinfection  of  rooms.  Under  the  latter  system 
carbolic  acid  may  be  used  for  minor  domestic  purposes,  sulphate  or 
perrhloride  of  iron  to  any  masses  of  filth,  and  sulphurous  acid  gas 
for  disinfection  of  rooms.  These  systems  do  not  combine  well  with 
one  another,  and  in  the  choice  which  has  to  be  made  between  them, 
it  will  be  convenient  that  the  sanitary  authority  of  each  district 
should  declare  which  of  the  two  systems  it  adopts,  and  that  all 
private  disinfection  in  the  district  should  follow  such  lead  of  the 
authority.  The  detail  in  each  case  should  be  carried  out  under 
medical  advice.  In  public  disinfection  establishments  for  the  dis- 
infection of  wearing  apparel,  bedding,  curtains,  and  other  large 
household  articles,  the  most  convenient  process  consists  in  employ- 
ment of  high  degrees  of  heat. 


X. — SUGGESTIONS  by  the  SOCIETY  of  MEDICAL  OFFICERS  of 
HEALTH,  for  Preventing  the  Spread  of  Infectious  or 
Contagious  Diseases,  such  as  SCARLET  FEVER,  SMALL- 
POX, FEVER,  etc. 

1.  Separate  the  sick  person  from  the  rest  of  the  family  directly 
illnes.-  appears,  placing  him,  if  possible,  in  a  room  at  the  top  of  the 
house,  and  taking  cart-  in  remove  carpets,  curtains,  and  all  unneces- 
sary articles  of  furniture  and  clothing  therefrom. 

2.  Admit  fresh   air  l>y  opening  the  upper  sash  of  the  window. 
The  fireplace  should  be  kept  open,  and  a  fire  lighted  if  the  weather 
permits.     Fresh  air  should  be  freely  admitted  through  the  whole 
h<>use  by  means  of  open  windows  and  doors.     The  more  air  that 
passes  through  the  house,  the  less  likely  is  the  disease  to  spread. 

3.  Hang  up  a  sheet  outside  the  door  of  the  sick-room,  and  keep 
it  w»-t  with  a  mixture  made  either  witli  a  quarter  of  a  pint  of  car- 
bolic acid  (No.  4),  or  a  pound  of  chloride  of  lime  and  a  gallon  of 
water. 

4.  Everything  that  passes  from  the  sick  person  should  be  received 


i( 


478  APPENDIX. 

into  vessels  containing  half  a  pint  of  a  solution  of  green  copperas,  made 
by  dissolving  one  pound  of  the  copperas  in  a  gallon  of  water.  A 
like  quantity  of  the  solution  of  copperas  should  be  added  to  the  dis- 
charges before  emptying  them  into  the  closet. 

5.  Every  sink,  closet;  or  privy  should  have  a  quantity  of  one 
of  the  above-named  disinfectants  poured  into  it  daily,  and  the 
greatest  care  should  be  taken  to  prevent  the  contamination  of  well 
or  drinking  water  by  any  discharges  from  the  sick  person. 

6.  All  cups,  glasses,  spoons,  etc.,  used  by  the  sick  person  should 
be  first  washed  in  the  above-named  solution  of  carbolic  acid,  and 
afterwards  in  hot  water,  before  being  used  by  any  other  person. 

7.  No  article  of  food  should  be  allowed  to  remain  in  the  sick- 
room.    No  food  or  drink  that  the  sick  person  has  tasted,  or  that 
has  been  in  the  sick-room,  should  be  given  to  any  one  else. 

8.  All  bed  and  body  linen,  as  soon  as  removed  from  the  sick 
person,  and  before  being  taken  from  the  room,  should  be  first  put 
into  a  solution  of  carbolic  acid  of  the  above-mentioned  strength, 
remaining  therein  for  at  least  an  hour  and  afterwards  boiled  in 
water. 

9.  Instead  of  handkerchiefs,  small  pieces  of  rag  should  be  used, 
and  these,  when  soiled,  should  be  immediately  burnt. 

10.  Persons  attending  on  the  sick  should  not  wear  woollen 
garments,  as  they  are  likely  to  retain  infectious  poison ;  dresses  of 
cotton,  or  of  some  washable  material,  should  be  worn.     Nurses 
should  always  wash  their  hands  immediately  after  attending  to  the 
sick  person,  using  carbolic  acid  soap  instead  of  ordinary  soap. 

11.  It  is  of  the  utmost  importance  that  the  sick-room  be  not 
frequented  by  others  than  those  in  immediate  attendance  on  the  sick, 
as  the  clothing  of  visitors  is  very  liable  to  carry  away  infection. 

12.  The  scales  and  dusty  powder  which  peel  from  the  skin  in 
scarlet  fever,  and  the  crusts  in  smallpox,  being  highly  infectious, 
their  escape  may  be  prevented  by  smearing  the  body  of  the  sick 
person  all  over  every  day  with  camphorated  oil.     This,  and  the 
after  use  of  warm  baths  and  carbolic  acid  soap,  are  most  essential. 
The  sick  person  must  not  be  allowed  to  mix  with  the  rest  of  the 
family  until  the  peeling  has  entirely  ceased,  and  the  skin  is  perfectly 
smooth ;  clothes  used  during  the  time  of  illness,  or  in  any  way  exposed 
to  infection,  must  not  be  worn  again  until  they  have  been  properly 


13.  When  the  sickness  has  terminated,  the  sick-room  and  its 
contents  should  be  disinfected  and  cleansed.  This  should  be  done 
in  the  following  manner  : — Spread  out  and  hang  upon  lines  all 
articles  of  clothing  and  .bedding  ;  well  close  the  fireplace,  windows, 
and  all  openings ;  then  take  a  quarter  to  half  a  pound  of  brimstone, 


APPENDIX.  4*79 

broken  into  small  pieces ;  put  them  into  an  iron  dish,  supported 
over  a  pail  of  water,  and  set  fire  to  the  brimstone,  by  putting  some 
live  coals  upon  it.  Close  the  door,  and  stop  all  crevices,  and  allow 
the  room  to  remain  shut  up  for  twenty-four  hours.  The  rooms 
should  then  be  freely  ventilated,  by  opening  the  door  and  windows, 
the  ceiling  should^  be  whitewashed,  the  paper  stripped  from  the 
walls  and  burnt,  and  the  furniture,  and  all  wool  and  painted  work 
be  well  washed  with  soap  and  water  containing  a  little  chloride  of 
lime.  Beds,  mattresses,  and  articles  which  cannot  well  be  washed, 
should,  if  possible,  be  submitted  to  the  action  of  heat  in  a  disinfect- 
ing chamber,  usually  provided  by  the  local  authorities.  Until  this 
process  of  disinfection  is  effectually  carried  out,  the  room  cannot  be 
safely  occupied. 

14.  Children  should  not  be  allowed  to  attend  school  from  a 
house  in  which  there  is  infectious  disease,  as,  although  not  ill  them- 
selves, they  are  very  likely  to  carry  the  infection,  and  so  spread  the 
disease.     No  child  should  be  allowed  to  re-enter  a  school  without  a 
certificate  from  the  medical  attendant,  stating  that  he  can  do  so 
without  any  danger  of  infecting  other  children. 

15.  In  case  of  death,  the  body  should  not  be  removed  from  the 
room,  except  for  burial,  unless  taken  to  a  mortuary,  nor  should  any 
article  be  taken  from  it  until  disinfected  as  before  directed  in  Kule 
No.  1 3.     The  body  should  be  put  into  a  coffin  as  soon  as  possible, 
with  a  pound  or  two  of  carbolic  powder.     The  coffin  should  be 
fastened  down,  and  the  body  buried  without  any  delay. 

Attention  is  particularly  directed  to  the  following  provisions 
of  the  Sanitary  Laws,  in  reference  to  "  Infectious  Dis- 
orders "  : — 

1.  The  owner  or  occupier  may  be  required  to  cleanse  and  disin- 
iVi-t  ;my  house  or  room,  or  the  cabin  or  berth  of  any  ship  or  vessel, 
and  the  articles  contained  in  it  likely  to  retain  infection — where 
infectious  disease  has  existed — under  a  penalty  not  exceeding  10s.  a 
day  for  neglect. 

2.  If  any  person,  suffering  from  any  dangerous  infectious  dis- 
order, shall  enter  a  cab  or  other  public  conveyance,  without  inform- 
ing the  driver  thereof  that  he  is  so  suffering,  he  shall  be  liable  to  a 
penalty  not  exceeding  £5. 

3.  Any  person  suffering  from  any  dangerous  infectious  disorder 
— such  as  fever,  scarlet  fever,  smallpox,  etc. — who  exposes  himself 
in  any  street,  school,  church,  chapel,  theatre,  or  other  public  place ; 
or  in  any  omnibus  or  other  public  conveyance,  and  any  person  in 


480  APPENDIX. 

charge  of  one  so  suffering,  who  so  exposes  the  sufferer,  shall  be  liable 
to  a  penalty  not  exceeding  .£5. 

4.  Any  person  who,  without  previous  disinfection,  gives,  lends, 
sells,  or  moves  to  another  place,  or  exposes  any  bedding,  clothing, 
rags,  or  other  things  which  have  been  exposed  to  infection,  becomes 
liable  to  a  penalty  not  exceeding  £5. 

5.  Any  person  who  lets  a  house,  room,  or  part  of  a  house,  in 
which  there  has  been  infectious  disease,  without  having  such  house 
or  room,  and  all  articles  therein  liable  to  infection,  disinfected  to  the 
satisfaction  of  a  qualified  medical  practitioner,  is  liable  to  a  penalty 
not  exceeding  £20.     This  applies  to  public -houses,  hotels,   and 
lodging-houses. 

6.  If  any  person  who  lets,  or  shows  for  hire,  any  house  or  part 
of  a  house,  makes  any  false  statement  as  to  the  fact  of  there  being 
then  in  such  house,  or  having  within  six  weeks  previously  been 
therein,  any  person  suffering  from  an  infectious  disease,  such  person 
answering  falsely  shall  be  liable  to  imprisonment,  with  or  without 
hard  labour,  or  to  a  penalty  not  exceeding  £20. 

J.  NORTHCOTE  VlNEN,  M.D.          J 

•St.  John's,  Southward,  (  „.       ,y 

W.  H.  CORFIELD,  M.D.  (Oxon.)  C* 

10  Bolton  Row,  Mayfair.        ) 
March  1875. 

XL — MEMORANDUM  with  respect  to  KETURNS  of  DEATHS 
from  Registrars  and  RETURNS  of  PAUPER  SICKNESS 
from  District  Medical  Officers. 

Under  Articles  14  and  15  of  Section  IV.  of  the  General  Order 
of  the  llth  November  1872,  every  medical  officer  of  health  whose 
appointment  has  been  approved  by  the  Board  is  required  to  prepare 
an  annual  report,  comprising,  amongst  other  things,  tabular  state- 
ments of  the  mortality  and  of  the  pauper  sickness  in  his  district. 
Information  as  to  mortality  and  sickness  is  required  by  the  medical 
officer  of  health  not  only  in  preparing  these  statements,  but  also 
in  discharging  the  duties  of  his  office,  and  this  Memorandum  is 
intended  to  indicate  the  arrangements  which  should  be  made  for 
furnishing  him  with  such  information. 

1.  The  sanitary  authority  should,  under  section  28  of  the 
Births  and  Deaths  Registration  Act,  1874,  require  the  Registrars  of 
Births  and  Deaths  to  supply  returns  of  the  deaths  registered  within 
their  respective  districts.  These  returns  should  be  made  weekly  as 
regards  all  deaths  registered  as  having  occurred  within  the  Registrar's 


APPENDIX.  481 

district  during  the  preceding  week  ;  but  an  immediate  notice  should 
be  given  of  all  deaths  from  infectious  disease  in  fresh  localities,  and 
of  all  groups  of  deaths  from  such  disease,  or  from  diarrhrea,  in 
any  localities.  The  Eegistrar-General  has  prepared  for  the  use  of 
Registrars  a  form  in  which  the  weekly  returns  may  be  conveniently 
made.  A  fee  of  twopence  for  each  entry  is  payable  by  the  sanitary 
authority. 

2.  The  medical  officer  of  health  should  be  regularly  supplied 
with  information  of  the  new  cases  of  pauper  sickness  in  his  district. 
This  information  is  valuable  to  him,  not  only  as  an  index  to  the 
prevalence  of  non-fatal  disease  among  all  classes  in  the  sanitary  dis- 
trict, but  as  giving  him  occasion  to  exercise  useful  and  immediate 
sanitary  supervision  over  localities  which  are  most  apt  to  require 
such  supervision.     It  is  requisite  for  this  object,  as  well  as  to  enable 
him  to  complete  the  annual  returns,  that  (except  where  the  medical 
officer  of  health  is  himself  the  Poor -Law  medical  officer  for  the 
whole  sanitary  area  under  his  superintendence,  in  which  case  he  will 
of  course  possess  this  information)  the  guardians  should  instruct 
their  clerk  to  copy  from  the  district  medical  officer's  relief  lists 
the  new  cases  whicli  are  reported  at  each  meeting  of  the  guardians, 
and  to  forward  the  same  promptly  and  regularly  to  the  medical 
officer  or  officers  of  health  within  the  union.     Arrangements  should 
be  made  for  the  regular  transmission  of  the  copies  referred  to  as 
early  as  practicable  after  each  meeting.     It  is  competent  to  the  sani- 
tary authority,  whether  rural  or  urban,  to  pay  a  reasonable  sum  to 
the  clerk  to  the  guardians  for  the  supply  of  this  information. 

3.  The  guardians  should  request  the  Poor-Law  medical  officers 
to   give   to  the   medical  officer  of  health  (or  to  the  inspector  of 
nuisances,  for  the  information  of  the  medical  officer  of  health)  acting 
within  their  respective  districts,  the  earliest  possible  information  of 
cases  of  dangerous  infectious  disease  under  their  charge  ;  as  it  is 
evident  that  unless  such  information  is  given  as  soon  as  the  cases 
occur,  the  action  of  the  sanitary  authority  in  regard  to  the  preven- 
tion of  infection  may  often  fail  in  its  effect. 

4.  Under  the  Board's   General  Order  of  the   12th  February 
1879,  it  is   incumbent  upon  all  district  and  workhouse  medical 
officers  appointed  since  the  28th  February  1879,  to  furnish  the 
iiu-dical  officer  of  health  with  returns  of  pauper  sickness  and  deaths, 
as  well  as  to  notify  the  outbreak  of  dangerous  infectious  disease.     A 
similar  obligation  lias  been  imposed  by  the  Board's  Order  of  the 
14th  June  1879  upon  medical  officers  of  district  schools  appointed 
after  the  25th  June  1879.  JOHN  LAMBERT,  Secretary. 

Local  Government  Board,  20th  July  1879. 
2  I 


482  APPENDIX. 


XII. — ANNUAL  KEPORTS  of  MEDICAL  OFFICERS  of  HEALTH. 

Instructions. — Every  medical  officer  of  health,  appointed  under 
the  order  of  the  Local  Government  Board  dated  the  llth  November 
1872,  is  required  to  make  an  annual  report  With  regard  to  each 
sanitary  district,  or  division  of  a  district,  which  is  under  his  super- 
intendence. This  report  is  to  be  for  the  year  ending  the  31st  of 
December,  or,  if  the  officer  at  that  date  has  not  been  in  office  for 
a  whole  year,  then  for  so  much  of  the  year  as  has  elapsed  since  .Ms 
appointment.  The  report  is  to  be  made  to  the  sanitary  authority, 
and  a  copy  of  it  is  to  be  sent  by  the  medical  officer  of  health  to  the 
Local  Government  Board.  It  should  be  made  as  soon  as  practicable 
after  the  expiration  of  the  year  to  which  it  relates.  The  medical 
officer  of  health  ought  not,  in  general,  to  have  any  difficulty  in  doing 
this  within  a  month  or  six  weeks  ;  but  if  from  any  special  circum- 
stances the  report  cannot  be  completed  within  six  weeks,  it  should 
be  understood  that  the  delay  must  not  be  indefinite,  and  that  the 
report,  complete  or  incomplete,  should  be  in  the  hands  of  the  sani- 
tary authority  within,  at  most,  three  months  from  the  end  of  the 
year.  The  Board's  copy  of  the  report  should  be  forwarded  to  them 
when  the  original  is  sent  to  the  sanitary  authority,  except  where 
the  report  is  likely  to  be  printed  by  order  of  the  authority.  In 
such  cases  the  Board 'need  only  be  supplied  with  a  printed  copy. 
But  in  all  cases  in  which  the  report  cannot  be  sent  to  the  Board 
within  six  weeks  from  the  end  of  the  year,  they  should  be  informed 
by  the  medical  officer  of  health  as  to  the  reason  for  the  delay. 

Article  14  of  Section  IV.  of  the  Board's  Order  provides  that  the 
annual  report  is  to  contain  information  as  to  the  sickness  and  deaths 
that  have  occurred  during  the  year ;  the  measures  taken  in  order  to 
prevent  the  spread  of  disease  ;  and  the  proceedings  of  the  medical 
officer  of  health.  It  would  be  well  if  the  report,  so  far  as  it  relates 
to  the  medical  officer  of  health's  proceedings,  were,  in  the  main,  the 
same  in  arrangement  as  the  articles  which  deal  with  these  proceed- 
ings ;  thus  stating  first  what  has  been  done  under  articles  1-3, 
which  make  it  the  duty  of  the  medical  officer  of  health  to  inform 
himself  as  to  the  sanitary  state  of  the  district,  and  to  make  the 
inquiries  and  inspections  necessary  for  this  purpose  ;  next,  the  advice 
which  has  been  given  to  the  sanitary  authority  under  articles  4  and 
5  ;  and  lastly,  the  action  he  has  taken  under  articles  6-10  in  the 
several  matters  therein  referred  to. 

As  regards  the  duties  imposed  under  these  several  articles,  each 
of  which  will  thus  be  reported  on,  special  attention  should  be  had 
to  the  provisions  of  article  3,  which  directs  systematic  inspections  of 


APPENDIX.  483 

t 

the  district  to  be  made  by  tlie  medical  officer  of  health,  apart  from 
the  inquiries  which  under  other  articles  of  the  Order  he  has  to  make 
into  particular  outbreaks  of  disease,  or  into  unwholesome  conditions 
to  which  his  attention  may  have  been  specially  called  by  complaints 
or  otherwise.  The  object  of  these  systematic  inspections  is  that  the 
medical  officer  of  health  may  assure  himself  that  he  is  well  acquainted 
with  all  the  discoverable  circumstances  which  are  likely  to  affect 
the  public  health  in  his  district.  How  often  these  inspections  re- 
quire to  be  made,  and  how  detailed  the  inquiries  should  be,  must 
be  determined  by  the  particular  circumstances  of  the  locality.  In 
some  neighbourhoods  a  house-to-house  inspection  should  as  far  as 
practicable  be  made  ;  in  others  this  may  not  be  needful  ;  but  every 
medical  officer  of  health  should  at  certain  times  set  himself  to 
examine  into  the  state  of  his  district,  devoting  some  time  to  each 
portion  of  it,  so  as  to  be  sure  that  no  part  escapes  his  notice.  In 
making  such  an  inspection  the  medical  officer  of  health  will  usually 
require  the  assistance  of  the  inspector  of  nuisances.  Of  these 
inspections,  of  the  judgment  he  has  formed  thereon  as  to  the  sani- 
tary state  of  the  district,  and  of  the  advice  he  has  in  consequence 
given  to  the  sanitary  authority,  and  the  action  taken  by  the  autho- 
rity thereon,  the  annual  report  should  contain  a  full  account. 

As  regards  the  tabular  statements  of  sickness  and  mortality 
(forms  for  which  statements  are  now  issued  by  the  Board)  only  one 
observation  appears  to  be  needful.  The  district  under  the  super- 
intendence of  a  medical  officer  of  health  will  often  contain  several 
parts  evidently  differing  in  their  circumstances,  or  having  very  differ- 
ent death-rates,  either  of  all  registered  deaths,  or  of  those  from  some 
particular  disease  or  class  of  diseases.  T,he  observation  of  these  differ- 
ences can  scarcely  fail  to  lead  to  valuable  information,  and  it  is  in 
view  of  those  differences  that  in  article  14  the  tabular  statements 
are  required  to  be  classified  according  to  localities,  and  that  provision 
for  such  a  classification  is  made  in  the  enclosed  forms  for  returns  of 
deaths.  In  the  absence  of  any  ascertained  differences  of  the  above 
sort,  it  will  still  be  desirable  to  classify  the  deaths  of  the  district 
according  to  the  part  of  the  district  in  which  they  occur  ;  and  for 
this  purpose  any  areas  of  known  population  (such  as  parishes,  groups 
of  parishes,  townships,  or  wards)  may  be  taken  as  representing 
"localities"  for  the  purposes  of  the  Order.  Classification  on  this 
basis  will  be  likely  to  lead  to  the  discovery  of  real  differences  when 
tin-  returns  for  several  years  can  be  compared  together. 

Having  regard  to  the  imperfect  character  of  the  information 
which  is  obtainable  as  to  non-fatal  sickness,  such  a  classification 
cannot,  it  seems,  be  generally  attempted  in  the  sickness  returns  ; 
but  in  particular  cases  medical  officers  of  health  may  be  able,  and 


484  APPENDIX. 

may  find  it  useful,  so  to  classify  the  pauper  sickness  of  which  they 
receive  information. 

What  has  been  said  above  with  regard  to  the  information  which 
an  annual  report  should  contain  must  be  understood,  not  as  suggest- 
ing that  the  report  should  be  limited  to  these  subjects,  or  that  more 
detailed  or  differently  arranged  tabular  statements  may  not  be 
added,  but  as  indicating  the  minimum  of  information  which  will 
satisfy  the  requirements  of  the  Board's  Order.  Many  medical 
officers  of  health  will  doubtless,  and  with  great  advantage  to  the 
administration  of  their  district,  give  much  more  detailed  informa- 
tion than  they  are  actually  required  to  furnish,  ancj.  will  give  espe- 
cial prominence  to  the  questions  to  which  they  have  been  led  by 
the  circumstances  of  the  past  year  to  devote  particular  attention,  or 
in  the  investigation  of  which  they  may  have  arrived  at  valuable  con- 
clusions. Any  information  of  this  kind  will  be  gladly  received  by 
the  Local  Government  Board. 

EDWARD  0.  SEATON,  M.D., 
Medical  Officer. 

Local  Government  Board,  December  1877. 


APPENDIX. 


485 


II 

1 

| 

1^ 

i 

I 

4S 

i 

it 

Q 

o 

O 

S 

S  I 

|i 

c 

'C   -M" 

r-       QJ 
^     -§ 

0 

o 
T 

a 
i—  i 

• 

s 

S 

CO     ®* 

1 

1 

« 

•k 

"orms  for  the  birth. 
Tom  Messrs.  Knig 
erthyr-Tydlil. 

1 

| 

1 

ill 

0   ,_, 

J   § 

486 


APPENDIX. 


XIV. — NOTICE  of  INFECTIOUS  DISEASES  occurring  amongst 
PAUPERS.     (Author's  Form.) 

SANITARY  AUTHORITY. 

Return  of  District  Medical  Officer. 


Name. 

Age. 

Residence. 

Disease. 

Probable 
Cause. 

Steps 
recommended. 

To  be  folded  and 

forwarded,  unsealed,  to 

Sanitary  Inspector. 


Signed, 


Date, 


District  Medical  Officer. 


Return  of  Sanitary  Inspector. 


Sanitary  Condition  of  Premises. 


Action  taken. 


To  be  folded  and 

forwarded,  unsealed,  to 

Medical  Officer  of 

Health. 


Signed, 


Date, 


Sanitary  Inspector. 


Explanatory  Note. — The  above  form  should  be  printed  on  paper  foolscap 
size,  with  the  Returns  of  the  District  Medical  Officer  and  Sanitary  In- 
spector on  one  side,  and  the  addresses  of  the  Medical  Officer  of  Health  and 
Sanitary  Inspector  on  the  other. 


APPENDIX.  487 


XV. — FORMS  of  TABLES  of  MORTALITY  issued  by  the 
SOCIETY  of  MEDICAL  OFFICERS  of  HEALTH. 

The  accompanying  forms  of  Tables  of  Mortality  have  been 
drawn  up  by  the  Society  of  Medical  Officers  of  Health  to  take  the 
place  of  those  issued  in  1874  ;  the  Society  being  of  opinion  that 
certain  changes  are  necessary,  as  the  result  of  a  new  nomenclature 
of  diseases  prepared  by  the  Royal  College  of  Physicians,  and  a 
new  method  of  classification  adopted  by  the  Registrar-General  of 
England  and  Wales. 

In  issuing  these  forms  the  Society  wish  again  to  express  their 
opinion  that  it  is  desirable  that  the  returns  of  all  medical  officers 
of  health,  in  England  and  Wales,  should  be  based  on  a  uniform 
system,  and  they  have,  therefore,  so  arranged  these  forms  that  they 
can  be  conveniently  used  by  those  medical  officers  of  health  who 
report  to  the  Local  Government  Board,  as  well  as  by  all  others. 

The  Society  also  again  recommend  that — 

1.  All  statistical  returns  be  made  out  to  the  end  of  the  registration 

year,  as  defined  in  the  reports  of  the  Registrar-General,  viz. 
up  to  December  31  or  thereabouts. 

2.  That  the  numbers  of  the  tables  adopted  by  the  Society  be  in 

all  cases  appended  to  these  tables  when  used  ;  and  that,  to 
avoid  confusion,  different  numbers  be  assigned  to  any  other 
tables  which  it  may  be  thought  fit  to  insert  in  an  Annual 
Report. 

The  purport  of  each  table  is  fully  explained,  the  rates  of 
mortality  should  in  each  table  be  calculated  on  the  corrected 
number  of  deaths  given  in  Table  III.,  and  it  is  thought  that  the 
information  contained  in  the  table  headed  "Summary  of  Table 
III."  might,  with  advantage,  be  given  in  the  body  of  the  Report. 

J.    NORTHCOTE    VlNEX,  M.D.,  \ 

St.  John's  South wark,  S.E.  ( 


Hon.  Sees. 

158  Camden  Road,  N.W. 
London,  1883. 


SHIRLEY  F.  MURPHY,  ( 

rj 


488 


APPENDIX. 


TABLJE    I. 

Showing  the  Population,  Inhabited  Houses,  Marriages,  Births,  and 
Deaths,  for  the  Year  18  and  10  years  preceding. 

GROSS  NUMBERS. 


The 
Year.i 

Estimated 
Population. 

No.  of 
Inhabited 
Houses. 

f 

Registered 
Births. 

CORRECTED  NUMBER 
OF  DEATHS. 

Deaths 
in  Public 
Institutions. 

Total 
all 
Ages. 

Under 
One 
Year. 

Under 
Five 

Years. 

18 

18 

18 

18 

18 

18 

18 

18 

18 

18 

18 

Average  of) 
10  Years,    Vj 
18    —18    J 

NOTES. 

1.  Population  at  Census  18 

2.  Average  Number  of  Persons  in  each  house  at  Census  18 

3.  Area  of  District  in  acres. 

1  For  statistical  purposes  the  Registrar-General  estimates  the  population  to  the 
middle  of  the  year  on  the  basis  of  the  rate,  of  increase  ruling  between  the  two  preceding 
census  periods.  The  estimate  of  population  may  be  checked  by  the  known  number  of 
inhabited  houses,  and  by  the  average  number  of  inmates  per  house,  as  ascertained  at 
the  preceding  census. 


APPENDIX. 


489 


o 

S  "S  °O 

~   '-  —  ~z 
S  >—  i     H 

hi 

ll'^I 

||T| 

- 

^|«3 

^  =  ""^ 

Q 

= 

i  ..     ^ 

!T    ®    t-  S 

Pi 

ia 

Correct 

].(•! 
1'i'l'Ulill  i' 

1 

*-*-* 

2 

oo 

OOOOCOOOQOOOOOOOOOOO 

O^rn 

490 


APPENDIX. 


TABLE    III. 

Showing  Deaths  registered  from  all  Causes  during  the  Year  18 

NOTE. — The  Deaths  of  non-Residents  occurring  in  Public  Institutions  situated  in 
the  District  are  excluded,  and  the  Deaths  of  Residents  occurring  in  Public  Institutions 
situated  beyond  the  limits  of  the  District  are  included. 


J.  —  Specific  Febrile,  or  Zy- 
motic Diseases. 
II.  —  Parasitic  Diseases. 
III.  —  Dietic  Diseases. 
IV.  —  Constitutional  Diseases. 
V.  —  Developmental  Diseases. 
VI.  —  Local  Diseases. 
VII.  —  Deaths  from  Violence. 
VIM.—  Deaths  from  Ill-defined 
and  not  Specified  Causes, 

Totals    . 

AGES. 

TOTALS. 

55 
to 

60 

i 

0 
to 
1 

1 

to 
5 

5 

to 
15 

15 

to 
25 

25 
to 
35 

35 

to 
45 

45 
to 
55 

55 
to 
65 

65 
to 
75 

75 
to 
85 

If 

1.  —  Specific  Febrile  or  Zymotic 
Diseases. 

1.  Miasmatic  Diseases. 
(  Vaccinated    . 
Smallpox  -j  Unvaccinated 
I^No  Statement 
Measles    ...... 
Scarlet  Fever    .         . 
Typhus     
Whooping-  Cough      .... 
Diphtheria        ..... 
Simple    Continued    and    Ill-defined 

Enteric  or  Typhoid  Fever 
Other  Miasmatic  Diseases 

2.  Diarrhceal  Diseases. 
Simple  Cholera         .... 
Diarrhoea,  Dysentery 

3.  Malarial  Diseases. 
Remittent  Fever       .... 
Ague         

1  By  filling  in  this  column  the  Statistics  of  Table  III.  will  be  made  comparable 
with  those  of  the  Weekly  and  Quarterly  Returns  of  the  Registrar-General,  and  also 
available  for  the  Reports  required  by  the  Local  Government  Board. 


APPENDIX. 


491 


AG 

ES 

• 

oa 

a 

o 

. 

>25 

5 

5 

6 

5 

g"E 

5 

> 

(i 

(i 

>  to 

)      0 

0 

0 

0 

88  § 

o 

0 

5 

)35 

>    5 

5 

5 

5 

g| 

H 

0 

4.  Zoogenous  Diseases. 

Cow-pox  and  effects  of  Vaccination  . 

Other    Diseases    (e.g.    Hydrophobia, 
Glanders,  Splenic  Fever) 

5.   Venereal  Diseases. 

Syphilis    

Gonorrhoea,  Stricture  of  Urethra 

6.  Septic  Diseases. 

Erysipelas         

Pyaemia,  Septicaemia 

Puerperal  Fever        .... 

II.  —  Parasitic  Diseases. 

Thrush,  and  other  Vegetable  Para- 

sitic Diseases         .... 

Worms,  Hydatids,  and  other  Animal 

Parasitic  Diseases 

III.  —  Dietic  Diseases. 

Want  of  Breast  Milk,  Starvation 

• 

Chronic  Alcoholism  .... 

Delirium  Tremens     .... 

IV.  —  Constitutional  Diseases. 

Rheumatic  Fever,  Rheumatism  of  the 

Heart   .         .         .         . 

Rheumatism     ..... 

Gout         .'..... 

Rickets     ...... 

Cancer,  Malignant  Disease 

Tabes  Mesenterica     .... 

Tubercular  Meningitis,  Hydrocephalu 

Phthisis    

Other  forms  of  Tuberculosis,  Scrofula 

1'urpura.  Ihi'iiiorrha^i'-  1  Matin-sis 

Ai  i.i  -miii,  Chlorosis,  Leucocythaemia  . 

Glycosuria,  Diabetes  Mellitus   . 

Other  Constitutional  Diseases    . 

492 


APPENDIX. 


V.  —  Developmental  Diseases. 

Premature  Birth 
Atelectasis        .... 
Congenital  Malformations 
Old  Age   ..... 


VI. — Local  Diseases. 

1.  Diseases  of  Nervous  System. 

Inflammation  of  Brain  or  Membranes 
Apoplexy,  Softening  of  Brain,  Hemi- 

plegia,  Brain  Paralysis 
Insanity,    General   Paralysis   of   the 

Insane ..... 
Epilepsy  ..... 
Convulsions      .         . 
Laryngismus    Stridulus    (Spasm    of 

Glottis)         .         .         . 
Disease  of  Spinal  Cord,  Paraplegia, 

Paralysis  Agitans 
Other  Diseases  of  Nervous  System    . 


2.  Diseases  of  Organs  of  Special  Sense. 
.g.  of  Ear,  Eye,  Nose)     . 

3.  Diseases  of  Circulatory  System. 

Pericarditis       .         .         . 
Acute  Endocarditis  . 
Valvular  Diseases  of  Heart 
Other  Diseases  of  Heart    . 
Aneurism          .... 
Embolism,  Thrombosis     . 
Other  Diseases  of  Blood-  Yessels 

4.  Diseases  of  Respiratory  System. 

Laryngitis 
~roup 

niphysema,  Asthma 
Bronchitis 
3neumonia 
Pleurisy   . 
Other  Diseases  of  Respiratory  System 


AGES. 


APPENDIX. 


493 


5.  Diseases  of  Digestive  System. 

AGES. 

1 

0 
to 

1 

1 
to 
5 

5 
to 
15 

15 

to 

L'5 

2fi 

fa 

:;5 

35 
t< 
45 

45  '55  65 
to  to  to 
5565  75 

75 
t< 

Sf 

!| 

55 
to 
GO 

Dentition         
Sore  Throat,  Quinsy 
Diseases  of  Stomach  .... 
Enteritis  ...... 
Obstructive  Diseases  of  Intestine 
Peritonitis        ..... 
Ascites     ...... 
Cirrhosis  of  Liver     .... 
Jaundice  and  other  Diseases  of  Liver 
Other  Diseases  of  Digestive  System  . 

• 

6.  Diseases  of  Lymphatic  System. 

(e.g.  of  Lymphatics  and  of  Spleen)     . 

7.  Diseases  of  Glandlike  Organs  of 
Uncertain  Use. 

(e.g.  Bronchocele,  Addison's  Disease). 

•  8.  Diseases  of  Urinary  System. 

Nephritis          ..... 
Bright's  Disease,  Albuminuria  . 
Disease  of  Bladder  or  of  Prostate 
Other  Diseases  of  the  Urinary  System 

9.  Diseases  of  Reproductive  System. 

(a.)  OF  ORGANS  OF  GENERATION. 

Male  Organs     ..... 
Female  Organs          .... 

(J.)   OF  PARTURITION. 

Abortion,  Miscarriage 
Puerperal  Convulsions 
Placeflta  pnevia,  Flooding 
Other  Accidents  of  Childbirth  . 

10.  Diseases  of  Bones  and  Joints. 

Caries,  Necrosis        .... 
Arthritis,  Ostitis,  Periostitis     . 
Other  Diseases  of  Bones  and  Joints  . 

494 


APPENDIX. 


11.  Diseases  of  Integumentary  System. 

AGES. 

d 

•<! 

55 
to 
60 

0 

;o 
1 

1 

:o 

5 

5 
to 

15 

15 
to 
25 

25 

XI 

35 

35 
to 

45 

45 
to 
35 

55 
X) 

05 

65 
;o 

75 

75 
50 

85 

•*% 

S£ 

£& 

Carbuncle,  Phlegmon 
Other     Diseases    of    Integumentary 
System         ..... 

VII.—  Deaths  from  Violence. 

1.  Accident  or  Negligence. 

Fractures  and  Contusions 
Gunshot  "Wounds 
Cut,  Stab          .         .         ... 
Burn,  Scald      .... 
Poison      .....- 
Drowning         .... 
Suffocation        .  .      . 
Otherwise         .... 

2.  Homicide. 

Manslaughter  ..... 
Murder    

3.  Suicide. 

Gunshot  Wounds      .... 
Cut,  Stab          .         .         . 
Poison      ...... 
Drowning         ..... 
Hanging  
Otherwise         

4.  Execution. 

Hanging  ...... 

VIM.—  Death  from  Ill-defined 
and  not  Specified  Causes. 

Debility,  Atrophy,  Inanition    . 
Mortification     ..... 

Abscess     ...... 
Haemorrhage     ..... 
Sudden  Death  (cause  not  ascertained) 
Causes  not  Specified  or  Ill-defined     . 

APPENDIX. 


495 


SUMMARY    OF   TABLE    III. 


I. — SPECIFIC  FEBRILE,  on  ZYMOTIC  DISEASES    . 

1.  Miasmatic  Diseases        ..... 

2.  Diarrhceal     ....... 

3.  Malarial 

4.  Zoogenous    ....... 

5.  Venereal       ....... 

6.  Septic 

II.— PARASITIC  DISEASES 

III. — DIETIC  DISEASES 

IV.  —CONSTITUTIONAL  DISEASES 

V. — DEVELOPMENTAL  DISEASES 

VI. —LOCAL  DISEASES         ...... 

1.  Diseases  of  Nervous  System  .... 

2.  Diseases  of  Organs  of  Special  Sense 

3.  Diseases  of  Circulatory  System 

4.  Diseases  of  Respiratory  System 

5.  Diseases  of  Digestive  System 

6.  Diseases  of  Lymphatic  System 

7.  Diseases  of  Glaudlike  Organs  of  Uncertain  Use 

8.  Diseases  of  Urinary  System   .... 

9.  Diseases  of  Reproductive  System   . 

(a. )  Diseases  of  Organs  of  Generation  . 

(b. )  Diseases  of  Parturition   .... 

10.  Diseases  of  Bones  and  Joints 

11.  Diseases  of  Integumentary  System 

VII. — VIOLENCE 

1.  Accident  or  Negligence         .... 

2.  Homicide      ....... 

3.  Suicide     .     .         .         . 

4.  Execution     ....... 

VIII. — ILL-DEFINED  AND  NOT  SPECIFIED  CAUSES    . 

TOTAL 


No.  of 
Deaths. 


496 


APPENDIX. 


TABLE    IV. 

Showing  the  Number  of  Deaths  at  all  ages  in  18  from  certain 

groups  of  Diseases,  and  proportions  to  1000  of  Population,  and 
to  1000  Deaths  from  all  causes  ;  also  the  Number  of  Deaths  of 
Infants  under  One  Year  of  age  from  .other  groups  of  Diseases, 
and  proportions  to  1000  Births  and  to  1000  Deaths  from  all 
causes  under  One  Year. 


DIVISION  I. 
(Adults.) 

Total  Deaths. 

Deaths  per  1000 
of  Population, 
at  all  ages. 

Deaths  per  1000 
of  Total  Deaths, 
at  all  ages. 

1.  Principal  Zymotic  Dis- 
eases 

2.  Pulmonary  Diseases    . 

3.  Principal    Tubercular 
Diseases  . 

DIVISION  II. 
(Infants  under  One  Year.) 

Total  Deaths. 

Deaths  per  1000 
of  Births. 

Deaths  per  1000 
of  Total  Deaths, 
under  One  Year. 

4.  Wasting  Diseases 

5.  Convulsive  Diseases     . 

NOTES. 

1.  Includes   Smallpox,   Measles,   Scarlet  Fever,   Diphtheria,   Whooping- 
Cough,    Typhus,    Enteric   (or    Typhoid),    and    Simple    Continued 

Fevers,  and  Diarrhoea,  of  the  deaths  occurred  in  Hospitals 

situated  beyond  the  limits  of  the  District. 

3.  Includes  Phthisis,  Scrofula,  Tuberculosis,  Rickets,  and  Tabes. 

4.  Includes  Marasmus,  Atrophy,  Debility,   Want  of  Breast  Milk,   and 

Premature  Birth. 

5.  Includes    Hydrocephalus,     Infantile    Meningitis,    Convulsions,     and 

Teething. 


APPENDIX. 


497 


IP! 

oo 

JvM  - 

i—  i 

3 

3|d 

H  *     '       °° 

^O             r-« 

oo 

§!l|oO 

i—  i 
2 

Ifls  "I 

2g|H 

1 

>H 

d 

^•02     oo 

H 

c  2^  7 

« 

^>   ,"   ^ 

£ 

^    2 

.a 

1 

00 
»—  1 

1 

oo 

o    oo 

CO 

§     S 

I—  1 

1.8 

1       1> 

00 
1—  1 

&£ 

'§  .a 

oo 

7—1 

•s  ^ 

p_i    d 

oo 

7—  1 

1 

a 

00 

1 

00 

7—1 

1 

oo 

l-H 

"8 

g 

oo 

I-H 

| 

-s  • 

• 

' 

g     ' 

^ 

.X     .-1 

r 

i 

ri 

1-    J 

1 

H 

E 

0 

M 

• 

t>         r*           "^         ^       *C       »^            * 

x      . 

I 

rt     .~    ~      "~""^/'  ^~"    .2 

•f. 

I 

en 
| 

Totals—  E 
WALES 

2  K 


498 


APPENDIX. 


—       o 
^       ° 

a! 

CO     £3 
•       02 

I 


II 


•sasuorauing  -s-i  :  sSuipaaoojj  ^§8^ 


'spaqsAi.00  pasuaorj 


•osnjajj  Joq^o  pn^  i-eratuy  ' 
-§B^g  'guna  jo  suoi^inuinooy  jo 


•o^  papua^'B  pu«  paAiaoai 
suoi^oiunraraoo  jo  -o&—  fBAoraa'a  ^S 


'SZ8Z  '^OV  ^I«9H  °!tq«<I,,  jo 
•to  (<998T  favZremreSi,  8^ 
il^gg  aapun  paja^siSaa  sasnou  Suigpoq;  jo  ' 


'•0^8  'sure.ic[  ^JAV  pa^oauuoo  sadij 


•paj8Aoo  PUB  ' 


'pastreajo  suia^sio 


L 


'P9J8AOO  ' 


•0^9 


•0^9  ' 


'pasimio 


ire  jo  ssgnni  J9W«  P^^o^jnisia;  sgsnon 


'sastuigaj  'sgsnoji 


s^.u9uipu9ray 


PUB  S9snon  jo 
aoj  pgnssi  saapaQ 


'sgstmga  j  'sgsnoH  jo  suoi^oadsuj-aa:  jo 


•pa^oadsui  '- 


's9Si\OH  jo 


AHVXlNVg 


APPENDIX. 


499 


XVI. — COMPARISON  of  the  METRICAL  with  the  COMMON  ENGLISH 
MEASURES,  as  regards  Capacity  and  "Weight,  from  Tables 
arranged  by  Mr.  WARREN  DE  LA  RUE,  F.R.S. 


MEASURES  OF  CAPACITY. 

In  Cubic  Inches. 

In  Cubic  Feet 
=  1728  Cubic 
Inches. 

In  Pints 
34-65923  Cubic 
Inches. 

Millilitre,  or  cubic  centimetre     . 
Centilitre,  or  10  cubic  centimetres 
'Decilitre,  or  100  cubic  centimetres 
Litre,  or  cubic  decimetre    . 
Decalitre,  or  ceutistere 
Hectolitre,  or  decistere 
Kilolitre,  or  stere,  or  cubic  metre 
Myriolitre,  or  decastere 

0'061027 
0-610271 
6-102705 
61-027052 
610-270515 
6102-705152 
61027-051519 
610270-515194 

0-0000353 
0-0003532 
0-0035317 
0-0353166 
0-3531658 
3-5316581 
35-3165807 
353-1658074 

0-001761 
0-017608 
0-176077 
1-760773 
17'607734 
176-077341 
1760-775314 
17607734140 

1  cub.  in.  =16-3861759  cub.  centimetres.    1  cub.  ft.  =28  '31  531  19  cub.  decimetres. 
1  fluid  oz.  =  28  -4  c.  c.     1  gallon  =  4  '543457969  litres.     1  quart  =  1  '136  litre. 

MEASURES  OF  WEIGHT. 

In  English  Grains. 

In  Troy  Ounces 
=480  Grains. 

In  -Avoirdupois 
Lbs.  =  7000 
Grains. 

Milligramme     .        .    '    . 
Centigramme      .... 
Decigramme       .... 
Gramme     ..... 
Decagramme      .... 
11.  i  t<>'_rr;uiiiiu'      .... 
Kilogramme        .... 
Myriogramme     .... 

0-015432 
0'154323 
1-543235 
15-432349 
154-323488 
1543-234880 
15432-348800 
154323-488000 

0-000032 
0-000322 
0-003215 
0-032151 
0-321507 
3-215073 
32-150727 
321-507267 

G'0000022 
0-0000220 
Q'0002205 
0-0022046 
0-0220462 
0-2204621 
2-2046213 
22-0462126 

1  Grain  =  0-064798950  Gramm.-.               1  Ib.  Avd.  =  0  '45359265  Kilogr. 
1  Troy  oz.  =  31  '103496  Gramme.              1  Cwt.  =  50  '80237689  Kilogr. 

500  APPENDIX. 


XVII. — LIST  of  APPARATUS  and  EE-AGENTS. 

The  following  sets  of  apparatus  and  re -agents  mentioned  in 
different  parts  of  the  work  may  be  obtained  from  various  manu- 
facturing chemists,  such  as  Messrs.  Griffin  and  Sons,  Garrick  Street, 
Covent  Garden,  London  ;  Messrs.  Townson  and  Mercer,  Bishopgate 
Street,  London  ;  Messrs.  Sutton,  Norwich  ;  and  Messrs.  Harris  and 
Co.,  Bull  Ring,  Birmingham.  The  prices  quoted  are  of  course  sub-, 
ject  to  variation,  and  only  approximately  accurate  : — 

About 

Chemical  Balance £3   15     0 

Set  of  Gramme  Weights,   50  Grammes  to  1   Milli- 
gramme (Oertlings)         .          .          .         ".          .          1150 

For  the  Examination  of  Air. 

1-1  Litre  Measure  graduated  into  c.c.       .          .          ..  090 

4  Glass  Jars  to  hold  5000  c.c.  each          .          .          .  120 

1  India-rubber  Caps  for  ditto  (double  set)  .  .  1160 
1  Tall  narrow  Glass,  marked  to  measure  30  and 

60  c.c. 023 

1  Mohr's  Burette  50  c.c.  graduated  into  1-1  Oth          .  059 

1  Support  for  ditto  (Mahogany)       .          .          .          .  050 

1  Bellows  Pump  with  long  nozzle  (length  sufficient 

to  reach  to  the  bottom  of  the  jars) .  .          .          .  04 

2  Mixing  Jars  1  Pint 02 

6  Glass  Stirrers  for  ditto 00 

4  oz.  Turmeric  Paper    ......  0     0 

1  Box  of  Filter  Papers 02 

1  Glass  Funnel  4" 00 

4  oz.  Pure  Cryst.  Oxalic  Acid          .          .          .          .01 

1  Ib.  Calcium  Hydrate  (for  making  lime  water)          .          Oi 

2  Common  wet  and  dry  bulb  Thermometers  (Mason's) 

each 090 

For  the  Qualitative  Examination  of  Water. 

2  Tall  colourless  glass  Cylinders  2  ft.  high  1"  diam.  0  10  0 
1  Wide  mouth  colourless  glass  Flask  to  hold  about 

1000  c.c 010 

1  Nest  (12)  of  Test  Tubes 016 

1  Nest  Porcelain  Evaporating  Basins,  2,  4,  8,  and 

16  oz. 036 

1  Porcelain  Crucible  2  J"  diam 0  10  0 


APPENDIX.  501 

About 

1   Set  (6)  Clark's  Test  Glasses  1  oz.          .          .          .£016 

1  Set  (6)  Cylindrical  Test  Glasses  2  oz.  .         .          .  020 

Apparatus  for  making  sulphuretted  hydrogen 

water  (pint)       .          .          .          .          .          .  050 

6  oz.  SoL  Caustic  Potash 021 

6  „     ,,     Ammonium  Oxalate        .          .          .          .  0      1    10 

6  „     „     Barium  Nitrate 014 

6  „     „     Silver  Nitrate 034 

6  ,,     ,,     Nessler's  Test  Solution   .          .          .          .  025 

6  „     ,,     Ammonia,  strong   .          .          .          .          .  014 

6  „     „     Acetic  Acid  .          .          .-                   .          .  024 

6  „     „     Nitric  Acid,  dilute          .          .          .          .  0110 

6  ,,     ,,      Sulphuric  Acid,  pure  conctd.  .          .          .  021 

6  „     „     Hydrochloric  Acid,  dilute        .          .          .  017 

2  „      Potassium  Iodide          .          .          .          .          .  014 
2  ,,     Potassium  Permanganate       .          .          .          .  014 
6  ,,     Ferrous  Sulphide  lumps        .          .          .          .  003 
2  „         „        Sulphate 017 

For  t\e  Quantitative  Analysis  of  Water. 
Balance  and  Weights  as  above. 

1  Liebig's  Condenser  with  stand    .          .          .          .  0150 

2  Eetorts,  each 036 

1  Retort  Stand 070 

2  Burettes  50  c.c.,  and  graduated  1-1  Oth,  each          .  036 

1  Burette  50  c.c.,  and  graduated  1-1  Oth  with  glass 

stop-cock 076 

2  Pipettes,  2  c.c.,  eacli 006 

2  Pipettes,  5  c.c.,  graduated  1-1  Oth,  each         .          .  016 

2   Half-litre  Flasks,  each 016 

2  Flasks  to  hold  70  c.c.,  each                             .          .  010 
2  Flasks  to  hold  35  c.c.,  each         .                    ..006 

6  Nessler  Glasses,  50  c.c.,  each      .          .          .          .  016 

1   Platinum  Dish 400 

1   Bunsen  Burner 020 

1    Wash-bottle 016 

Nitrate  of  Silver,  pure,  per  oz.       .         .         .         .  040 

Permanganate  of  Potash    „            .         .         .         .  008 

•  P.  .lash                      „               ....  0      0      6 

S..ap  u->t  (Clark's)  per  Ib 040 

ut        „ 060 

Chloride  of  Ammonium  per  oz.       .          .          .          .  006 

Cliromate  of  Potash  003 


502  APPENDIX. 

For  the  Examination  of  Milk. 

About 

1  Lactometer  graduated  to  test  approximately  the 

percentage  of  adulteration  with  water  (in  a  case)  £0  3  0 

1  Tall  narrow  glass  vessel  graduated  to  test  percent- 
age of  cream  (in  a  case) 


INDEX. 


ABC  process  of  sewage -purification,  338. 
Ablution -rooms,  situation  of,  in  hospitals,  266. 
Aeroscope,  135. 
Ague,  production  of,  79. 

Air,  amount  of,  to  be  supplied  in  ventilation,  89. 
composition  of,  63 
effects  of  impure,  64. 
examination  of,  122. 
impurities  in,  64. 
movements  of,  in  ventilation,  100 
of  hospitals,  72,  259. 
of  sewers,  72. 
Air-bricks,  102. 
Air-flues,  119. 

Alkali  works,  injurious  gases  given  off  by,  78. 
Ambulance,  284,  461. 
Ammonia  in  air,  134. 

water,  185. 
Analysis  of  air,  121. 

water,  163. 

Anderson's  process  of  sewage-purification,  340. 
Anemometer,  124. 
Anthrax,  55,  81. 
Aqueduct,  construction  of,  154. 
Archimedean-screw  ventilator,  117. 
Arnott's  ventilator,  112. 
Artisans'  and  Labourers'  Dwellings  Act,  450. 
Ash.'s.  usr  of,  iii  privies,  308,  321. 
Ashpits,  308,  311. 

B 

BAKKII»  it  ion  Act,  450. 

Barracks,  ventilation  of,  96. 


504  INDEX. 

Basins,  lavatory,  267. 

Baths,  amount  of  water  required  for,  145. 

Baths  and  Washhouses  Acts,  450. 

Bedding,  disinfection  of,  390. 

Bird's  process  of  sewage-purification,  338. 

Birth-rate,  405. 

Black  Death,  6. 

Blyth's  process  of  sewage-purification,  337. 

Bone,  amount  of,  in  meat,  39. 

Braxy  in  sheep,  54. 

Bread,  examination  of,  45. 

Brickfields,  effluvia  arising  from,  78. 

Bromine  as  a  disinfectant,  385. 

Buildings,  new,  regulation  of,  282,  449. 

Burnett's  fluid  as  a  disinfectant,  385. 

Butcher-meat,  examination  of,  42. 

Butter,  examination  of,  47. 

By-laws,  subjects  to  which  they  apply,  451. 


CALCIUM  chloride  as  a  disinfectant,  387. 

Calorigen  stove,  111. 

Carbolic  acid  as  a  disinfectant,  385. 

Carbon-filtration  of  sewage,  341. 

Carbonic  acid,  amount  of,  given  off  by  the  lungs,  66. 

,,  ,,  in  air,  63. 

determination  of,  in  air,  127. 
physiological  effects  of,  68. 

Carriages  for  conveyance  of  infected  persons,  284,  461. 
Catchment-basins,  definition  of,  140. 
Cellar-dwellings,  regulation  of,  by  law,  436. 
Census,  how  taken,  395. 
Cesspools,  construction  of,  234. 

dangers  arising  from,  74,  165,  252. 
Charcoal  as  a  disinfectant,  383. 

filters,  160. 

ventilators,  296. 
Cheese,  examination  of,  47. 
Chemical  works,  injurious  gases  given  off  by,  78. 
Chicory,  detection  of,  in  coffee,  48. 
Chimneys,  ventilation  by,  106. 
Chloralum  as  a  disinfectant,  387. 
Chloride  of  lime  as  a  disinfectant,  387. 

zinc,  388. 
Chlorine  as  a  disinfectant,  384, 


INDEX.  505 

Cholera,  prevention  of,  369,  473. 

production  of,  by  impure  air,  75. 

,,  ,,  ,,      water,  204. 

Cisterns,  cleansing  of,  157,  167. 

construction  of,  157. 

Clark's  process  of  water-purification,  163. 
'Climate,  influence  of,  on  public  health,  425. 
Closets,  ash,  311. 

earth,  316. 

dry,  318. 

pail,  310. 

trough,  305. 

tumbler,  305. 

water,  236,  304. 
Clothing,  disinfection  of,  390. 
Coffe.e,  examination  of,  11. 
Collecting  water  for  analysis,  169. 
Common  lodging-houses,  436. 
Conduits,  construction  of,  for  water-supply,  154. 
Condy's  fluid  as  a  disinfectant,  387. 

as  a  water-purifier,  163. 
Cooper's  salts  as  a  disinfectant,  388. 
Copper  sulphate  as  a  disinfectant,  387. 
Cottage  hospitals,  269. 
Cowls,  use  of,  in  ventilation,  103. 
Cowsheds,  regulation  of,  459. 
Cubic  space,  necessary  amount  of,  for  requirements  of  health,  93. 

in  hospitals,  262,  278. 
Cupralum  as  a  disinfectant,  386. 

D 

DAIRIES,  regulation  of,  459. 
Death-rates,  406. 

Diarrhoea,  production  of,  by  impure  air,  75,  381. 
,,  ,,         impure  water,  226. 

,,  ,,         unwholesome  food,  53. 

summer,  381 

Dietaries,  construction  of,  38. 
of  convicts,  36 
of  low-fed  operatives,  35. 
of  well-fed  operatives,  36. 
Diphtheria,  60,  226,  379. 

Diseases,  prevention  of  infectious,  362,  445,  473,  477. 
propagation  of  infectious,  369. 
traceable  to  sanitary  defects,  248. 


506  INDEX. 

Disinfectants,  382. 
Disinfecting-chamber,  280,  383,  391. 
Disinfection,  389,  477. 
Drains,  house,  construction  of,  232,  294. 
Drain-sewers,  construction  of,  294. 
Dust-bins,  construction  of,  328. 
Dwellings,  site,  229. 

sanitary  inspection  of,  248. 

structural  details  of,  231. 

unfit  for  habitation,  247,  437. 
Dysentery,  production  of,  by  impure  water,  226. 

E 

EARTH  closets,  316. 

Effluvia  from  decomposing  animal  matter,  effects  of,  77. 
from  sewers  and  cesspools,  effects  of,  72. 
from  offensive  trades,  80,  86,  441. 
Eggs,  examination  of,  45. 
Enteric  fever,  prevention  of,  372,  473,  477. 

production  of,  by  impure  air,  73. 

,,  by  impure  water,  208. 

,,  by  pdlluted  milk,  59. 

Epidemics,  management  of,  473. 
Ergot  of  rye,  effects  of,  52. 
Euthermic  stove,  111. 
Excreta,  composition  of,  334. 


FATTY  constituents  of  food,  functions  of,  29. 

Ferrous  sulphate  as  a  disinfectant,  388. 

Filter  beds,  159. 

Filters,  160. 

Filth  diseases,  249,  365. 

Filtration  of  sewage,  341. 

water,  159. 
Fireplaces,  106. 
Flour,  examination  of,  45.- 
Flues,  foul  air,  119,  239. 
Flushing  of  sewers,  298. 
Food,  diseases  connected  with,  49.    ' 

examination  of,  42. 

functions  and  constituents  of,  27. 

nutritive  equivalents  of,  31. 
Food  and  work,  32. 
Foods,  preserved,  40. 


INDEX.  507 

G 


GALTON'S  stove,  109. 

Gas,  combustion  of,  93. 

Gas-lights,  ventilation  by,  116. 

Goitre,  production  of,  by  impure  water,  200. 

Goux  system  of  excretal  removal,  310. 

Grates,  109. 

Graveyards,  air  of,  77. 

sanitary  condition  of,  429. 

H 

HEAT  as  a  disinfectant,  383. 
Hille's  process  of  sewage-purification,  339. 
Holden's        „  „  337. 

Hospitals,  cottage,  269. 

for  cases  of  infectious  disease,  272,  445 
pavilion,  260. 

rules  for  management  of,  462. 
Houses,  construction  of,  231. 

damp,  how  prevented,  236. 
drainage  of,  232. 
for  the  labouring  classes,  240. 
Humidity  of  air,  how  ascertained,  135. 
Huts,  hospital,  280. 
Hygiene  of  sick-room,  389. 

public,  definition  and  scope  of,  1. 
Hygrometers,  use  of,  136. 


INFECTIOUS  diseases,  origin  of,  362. 

prevention  of,  369,  449,  437. 

propagation  of,  369. 
Inlets  for  fresh  air,  situation  of,  118. 
Inoculation,  11. 

Inspectors  of  nuisances,  duties  of,  452. 
Intercepting  tanks,  307. 
Intermittent  downward  filtration,  341. 
Intermittent  fever,  production  of,  74,  201. 
Iodine  as  a  disinfectant,  385. 
Irrigation,  process  of  sewage,  343,  349. 
sanitary  aspects  of,  359. 

J 

JAIL-FEVER,  10. 


508  INDEX. 


LAKES,  quality  of  water  from,  141. 
Latrines,  construction  of,  306. 
Lead  acted  on  by  water,  155. 

effects  of,  201. 
Liebig's  extract  of  meat,  40. 
Lieurnur's  system  of  sewage -removal,  319. 
Life,  expectation  of,  417. 
Life-tables,  417. 

Lime  process  of  sewage-purification,  337. 
Lodging-houses,  96,  436. 
Louvres,  use  of,  in  ventilation,  103. 

M 

M'DOUGALL'S  disinfecting  powder,  387. 

M'Kinnell's  plan  of  ventilation,  105. 

Manurial  value  of  sewage,  335. 

Marriage-rate,  406. 

Marshes,  air  of,  79. 

Measles,  prevention  of,  378. 

Meat,  diseases  produced  by  unwholesome,  49. 

examination  of,  42,  445. 

preserved,  41. 

Medical  officers  of  health,  duties  of,  421. 
Meteorology,  425. 
Middens,  different  plans  of,  308. 
Milk,  examination  of,  46. 

preserved,  41. 

propagation  of  disease  by  means  of,  58. 

shops,  regulation  of,  459. 
Mines,  air  of,  80. 

ventilation  of,  115. 
Morbidity,  418. 
Mortality,  406. 
Mortuaries,  286. 
Moule's  earth-closet,  316. 

N 

NITROGENOUS  constituents  of  food,  functions  of,  27. 

Nitrous  acid  as  a  disinfectant,  384. 

Norton's  tube- well,  150. 

Noxious  trades  and  manufactures,  80,  441. 

Nuisances  defined,  436. 


INDEX.  509 


o 


OATMEAL,  examination  of,  46. 
Outlet  tubes,  construction  of,  119. 

situation  of,  119. 
Overcrowding,  438. 
Oxygen,  amount  of,  in  air,  63. 
Ozone,  64. 

P 

PAIL  system  of  excretal  removal,  310. 
Pavilion  hospitals,  260. 

Phosphate  process  of  sewage-purification,  238. 
Phthisis,  production  of,  by  impure  air,  71. 

production  of,  by  damp  soil,  353. 
Pipes,  water,  154. 
Pipe-sewers,  advantages  of,  293. 
Plagues,  6. 
Population,  enumeration  of,  395. 

estimates  .of,  398. 

Potassium  bichromate  as  a  disinfectant,  388. 
Potatoes,  examination  of,  48. 
Potts'  plan  of  ventilation,  104. 
Precipitation  processes  of  sewage-purification,  336. 
Preserved  meat,  41. 

milk,  41. 

vegetables,  41. 

Preventable  disease,  amount  of,  20, 
Preventive  measures,  369,  473,  477 
Prisons,  ventilation  of,  114. 
Purification  of  sewage,  336.    • 
of  water,  159. 

Q 

QUARANTINE,  446. 

R 

KAIN  as  a  source  of  water-supply,  139. 
Rainfall,  average  amount  of,  152. 
Rain-water,  composition  of,  139. 
Registration,  401. 
Relapsing  fever,  prevention  of,  375,  477. 

production  of,  51. 
Removal  of  sewage,  282. 
Reports,  sanitary,  how  to  write,  482. 

memorandum  concerning,  480. 


510  INDEX. 

Reservoirs,  construction  of,  152. 
Re-vaccination,  necessity  of,  471. 
Rickett's  ventilating  globe-light,  116. 
Ritchie's  plan  of  ventilation,  113. 
River  pollution,  332. 
River- water,  quality  of,  143. 


SACCHARINE  constituents  of  food,  functions  of,  30. 
Saline  matters,  functions  of,  in  food,  30. 
Sanitas,  as  a  disinfectant,  387. 
Sausages,  unwholesome,  effects  of,  53. 
Scarlet  fever,  prevention  of,  377,  477. 
propagation  of,  59,  377. 
Scavenging,  312,  327. 

Scott's,  General,  process  of  sewage-purification,  339. 
Scurvy,  production  of,  51. 

prevention  of,  9,  51. 
Sewage,  composition  of,  334. 

effluvia,  72. 

filtration,  341. 

irrigation,  343. 

purification  and  utilisation  of,  336. 

removal,  289. 

value  of,  335. 
Sewers,  construction  of,  292. 

flushing  of,  298. 

ventilation  of,  295. 

Sheringham  valve,  use  of,  in  ventilation,  102. 
Ships,  hospital,  285. 
Shone's  pneumatic  system,  300. 
Shorland's  grate,  109. 
Site,  choice  of,  for  hospitals,  259,  275. 

houses,  229. 

Slops,  village,  treatment  of,  349. 
Smallpox,  prevention  of,  11,  375,  463,  477. 
Soils,  influence  of,  on  health,  353. 
Springs,  quality  of  water  from,  142. 
Stallard's  plan  of  ventilation,  105. 
Statistics,  vital,  394,  429,  487. 
Stoves,  ventilating,  109. 
Streets,  construction  of,  330. 
Sulphurous  acid  gas  as  a  disinfectant,  385. 
Subirrigation,  351., 
Sun-burners,  use  of,  in  ventilation,  116. 


INDEX.  511 


Sweating  sickness,  6. 
Sylvester's  plan  of  ventilation,  103. 
Syphon  filter,  Bond's,  161. 
trap,  234. 


TANK,  intercepting,  Chesshire's,  307. 

Tank-filter,  Crease's,  155. 

Tea,  examination  of,  48. 

Temperature,  examination  of  air  as  regards,  135. 

'IV nts.  hospital,  280. 

Terebene  as  a  disinfectant,  386. 

Thermometers,  use  of  wet  and  dry  bulb,  135. 

Tobin's  system  of  ventilation,  102. 

Trades,  unwholesome,  80,  441. 

Traps,  301. 

Trichina  spiralis,  disease  produced  by,  55. 

Trough-closets,  305. 

Tumbler-closets,  305. 

Typhoid  fever,  prevention  of,  372,  473,  477. 

production  of,  by  impure  air,  73. 

,,  ,,  polluted  milk,  59. 

„  „  „        water,  208. 

Typhus  fever,  prevention  of,  373,  477. 
production  of,  70,  373. 

U 

T'RIXAI>.  construction  of,  308. 

Trine,  amount  and  composition  of,  334. 

Ttili/ation  of  sewage,  336. 


V\<  CIVATIOX,  rules  for,  •! 

Van  Hecke's  plan  of  ventilation,  117. 

Varley's  ,,  ,,  104. 

,l»les,  preserved,  41. 
Ventilation,  artificial,  106. 

natural,  99. 

of  hospitals,  264,  278. 

of  houses,  99,  239. 

of  house-drains,  232. 

of  mines,  80. 

of  sewers,  295. 

of  theatres,  118. 

of  water- closets,  238. 


512  INDEX. 

W 

WASTE-PREVENTERS,  157. 

Warming,  106. 

Water,  amount  of,  derivable  from  rainfall,  152. 

analysis,  169. 

collection  of,  169. 

distribution  of,  154. 

effects  of  impure,  198. 

functions  of,  in  food,  30. 

pollution  of,  164. 

purification  of,  159. 

qualities  of,  according  to  source,  144. 

quantity  of,  required  for  health  and  other  purposes,  144. 

sources  of,  139. 

Water-closets,  situation  and  construction  of,  236. 
Water-meters,  157. 
Waterworks,  150. 

Weare's  process  of  sewage-purification,  318. 
Wells,  147. 

Whitthread's  process  of  sewage-purification,  340. 
Whooping-cough,  prevention  of,  378. 
Windows,  ventilation  by,  101. 
Winds,  action  of,  in  ventilation,  99. 
Wool-sorters'  disease,  81. 

Z 

ZINC  chloride  as  a  disinfectant,  388. 
Zymotic  diseases,  362. 


THK  KND. 


CATALOGUE  No.  7. 


A  CATALOGUE 

OF 

BOOKS  FOR  STUDENTS; 

INc  I.I  1>IN<;    A    FULL    LIST   OF 

The  ?  Quiz-Coinpends  ? 

AND    MANY   OF 

THE   MOST   PROMINENT 

Students'  Manuals  and  Text-Books 


PUBLISHED    BY 


1'.  BLAKISTON,  SON  &  CO., 

Medical  Booksellers,  Importers  and  Publishers, 
No.  1012  WALNUT  STREET, 

PHILADELPHIA. 


***  For  sale  by  all  Booksellers,  or  any  book  will  be  sent  by  mail, 
postpaid,  upon  receipt  of  price.  Catalogues  of  books  on  all  branches 
of  Medicine,  Dentistry,  Pharmacy,  etc.,  supplied  upon  application. 


THE  PQUIZ-COMPENDS? 

A  NEW  SERIES  OF  COMPENDS  FOR  STUDENTS. 

For  Use  in  the  Quiz  Class  and  when 
Preparing  for  Examinations. 

Price  of  Each,  Bound  in  Cloth,  $1.00    Interleaved,  $1.25. 


Based  on  the  most  popular  text-books,  and  on  the  lec- 
tures of  prominent  professors,  they  form  a  most  complete 
set  of  manuals,  containing  information  nowhere  else 
collected  in  such  a  condensed,  practical  shape.  The 
authors  have  had  large  experience  as  quiz  masters  and 
attaches  of  colleges,  with  exceptional  opportunities  for 
noting  the  most  recent  advances  and  methods.  The 
arrangement  of  the  subjects,  illustrations,  types,  etc.,  are 
all  of  the  most  improved  form,  and  the  size  of  the  books 
is  such  that  they  may  be  easily  carried  in  the  pocket. 
No.  1.  ANATOMY.  (Illustrated.) 

THIRD  REVISED  EDITION. 

A  Compend  of  Human  Anatomy.     By  SAMUEL  O.  L. 
POTTER,  M.A.,  M.D.,  U.  S.  Army.  With  63  Illustrations. 

"  The  work  is  reliable  and  complete,  and  just  what  the  student 
needs  in  reviewing  the  subject  for  his  examinations." — The  Physi- 
cian and  Surgeon 's  Investigator,  Buffalo,  N.  Y. 

"To  those  desiring  to  post  themselves  hurriedly  for  examination, 
this  little  book  will  be  useful  in  refreshing  the  memory." — New 
Orleans  Medical  and  Surgical  Journal. 

"  The  arrangement  is  well  calculated  to  facilitate  accurate  memo- 
rizing, and  the  illustrations  are  clear  and  good." — North  Carolina 
Medical  Journal. 

Nos.  2  and  3.    PRACTICE. 
A  Compend  of   the   Practice  of    Medicine,  especially 
adapted  to  the  use  of  Students.  By  DAN'L  E.  HUGHES, 
M.D.,  Demonstrator  of  Clinical  Medicine  in  Jefferson 
Medical  College,  Philadelphia.     In  two  parts. 
PART  I. — Continued,  Eruptive,  and  Periodical  Fevers, 
Diseases  of  the  Stomach,  Intestines,  Peritoneum,  Biliary 
Passages,  Liver,  Kidneys,  etc.,  and  General  Diseases,  etc. 
PART  II. — Diseases  of  the  Respiratory  System,  Circu- 
latory System,  and  Nervous  System ;    Diseases   of  the 
Blood,  etc. 

*#*  These  little  books  can  be  regarded  as  a  full  set  of 
notes  upon  the  Practice  of  Medicine,  containing  the 


THE  ?  QUIZ-COMPENDS  ?. 


Synonyms,  Definitions,  Causes,  Symptoms,  Prognosis, 
Diagnosis,  Treatment,  etc.,  of  each  disease,  and  includ- 
ing a  number  of  new  prescriptions.  They  have  been 
compiled  from  the  lectures  of  prominent  Professors,  and 
reference  has  been  made  to  the  latest  writings  of  Pro- 
fessors FLINT,  DA  COSTA,  REYNOLDS,  BARTHOI.OW, 
ROBERTS  and  others. 

"  It  is  brief  and  concise,  and  at  the  same  time  possesses  an  accu- 
racy not  generally  found  in  compends." — yas.  M.  French,  M.D., 
Ass't  to  the  Prof,  of  Practice,  Medical  College  of  Ohio,  Cincinnati. 

"  The  book  seems  very  concise,  yet  very  comprehensive.     . 
An  unusually  superior  book." — Dr.  E.  T.  Bruen,  Demonstrator 
of  Clinical  Medicine,  University  of  Pennsylvania. 

"  I  have  used  it  considerably  in  connection  with  my  branches  in 
the  Quiz-class  of  the  University  of  La."— J.  H.  Bemiss,  Neiv 
Orleans. 

"  Dr.  Hughes  has  prepared  a  very  useful  little  book,  and  I  shall 
take  pleasure  in  advising  my  class  to  use  it." — Dr.  George  rV. 
Hall,  Professor  of  Practice,  St.  Louis  College  of  Physicians  and 
Surgeons. 

No.  4.    PHYSIOLOGY. 

A  Compend  of  Human  Physiology,  adapted  to  the  use 
of  Students.  By  ALBERT  P.  BRUBAKER,  M.D.,  De- 
monstrator of  Physiology  in  Jefferson  Medical  College, 
Philadelphia. 

"  Dr.  Brubaker  deserves  the  hearty  thanks  of  medical  students 
for  his  Compend  of  Physiology.  He  has  arranged  the  fundamental 
and  practical  principles  of  the  science  in  a  peculiarly  inviting  and 
accessible  manner.  I  have  already  introduced  the  work  to  my 
class." — Maurice  N.  Miller,  M.D.,  Instructor  in  Practical  His- 
tology, formerly  Demonstrator  of  Physiology,  University  City  of 
New  York. 

"  'Quiz-Compend'  No.  4  is  fully  up  to  the  high  standard  estab- 
lished by  its  predecessors  of  the  same  series." — Medical  Bulletin , 
Philadelphia. 

"  I  can  recommend  it  as  a  valuable  aid  to  the  student." — C.  N. 
Ellin-wood,  M.D.,  Professor  of  Physiology,  Cooper  Medical  Col- 

•'!  Francisco. 
"  Tliis  is  a  well  written  little  book." — London  Lancet. 

No.  5.     OBSTETRICS. 

A  Compend  of  Okstelries.  For  Physicians  and  Students. 
I'.y  HENRY  <',.  LAMMS,  M.I >.,  ProiVssor  of  Obstetrics 

and  Diseases  of  Women,  in  Starling  Medical  College, 

Columbus.     Illustrated. 

"  We  have  no  doubt  that  many  students  will  find  in  it  a  most  val- 
uable aid  in  preparing  for  examination." — The  American  Journal 
of  Obstetrics. 

"  It  is  complete,  accurate  and  scientific.  The  very  best  book  of 
its  kind  1  have  seen." — J.  S.  Kno.r,  Af.D.,  Lecturer  on  Obstetrics, 
Rush  Medical  College,  Chicago. 

Price  of  each  Book,  Cloth,  $1.00.    Interleaved  for  Notes,  $1.29. 


THE  ?  QUIZ-COMPENDS  ?. 


"  I  have  been  teaching  in  this  department  for  many  years,  and  am 
free  to  say  that  this  will  be  the  best  assistant  I  ever  had.  It  is  ac- 
curate and  comprehensive,  but  brief  and  pointed." — Prof.  P.  D. 
Yost,  St.  Louis. 

No.  6.    MATEBIA  MEDIOA.    Revised  Ed. 

A  Compend  on  Materia  Medica  and  Therapeutics,  with 
especial  reference  to  the  Physiological  Actions  of 
Drugs.  For  the  use  of  Medical,  Dental,  and  Pharma- 
ceutical Students  and  Practitioners.  Based  on  the  New 
Revision  (Sixth)  of  the  U.  S.  Pharmacopoeia,  and  in- 
cluding many  unofficinal  remedies.  By  SAMUEL  O. 
L.  Potter,  M.A.,M.D.,  U.  S.  Army. 


"  I  have  examined  the  little  volume  carefully,  and  find  it  just 
ach  a  book  as  I  require  in  my  private  Quiz,  and  shall  certainly  re- 
commend it  to  my  classes.  Your  Compends  are  all  popular  here  in 


Washington." — John  E.Brackett,  M.D.,  Professor  of  Materia 
Medica  and  Therapeutics,  Howard  Medical  College,  Washington. 
"  Part  of  a  series  of  small  but  valuable  text-books.  .  .  .  While 
the  work  is,  owing  to  its  therapeutic  contents,  more  useful  to  the 
medical  student,  the  pharmaceutical  student  may  derive  much  use- 
ful information  from  it." — N.  Y.  Pharmaceutical  Record. 

No.  7.     CHEMISTRY.    Revised  Ed. 

A  Compend  of  Chemistry.     By  G.  MASON  WARD,  M.D., 
Demonstrator  of  Chemistry  in  Jefferson  Medical  Col- 
lege, Philadelphia.    Including  Table  of  Elements  and 
various  Analytical  Tables. 
"  Brief,  but  excellent.  ...  It  will  doubtless  prove  an  admirable 

aid  to  the  student,  by  fixing  these  facts  in  his  memory.    It  is  worthy 

the  study  of  both  medical  and  pharmaceutical   students   in   this 

branch." — Pharmaceutical  Record,  New  York. 

No.  8.    VISCERAL  ANATOMY. 
A  Compend  of  Visceral  Anatomy.     By  SAMUEL  O.  L. 
POTTER,  M.A.,  M.D.,  U.  S.  Army.   With  40  Illustrations. 

*#*  This  is  the  only  Compend  that  contains  full  descriptions  of  the 
viscera,  and  will,  together  with  No.  i  of  this  series,  form  the  only 
complete  Compend  of  Anatomy  published. 

No.  9.     SURGERY.    Illustrated. 
A  Compend  of  Surgery;  including  Fractures,  Wounds, 
Dislocations,  Sprains,  Amputations  and  other  opera- 
tions,   Inflammation,    Suppuration,    Ulcers,    Syphilis, 
Tumors,  Shock,  etc.     Diseases  of  the  Spine,  Ear,  Eye, 
Bladder,  Testicles,  Anus,  and  other  Surgical  Diseases. 
By  ORVILLE  HORWITZ,  A.M.,  M.D.,  with  43  Illustra- 
tions. 
Price  of  Each,  Cloth,  $1.00.    Interleaved  for  Notes,  $1.25. 


THE  ?QUIZ-COMPENDS? 


No.  10.     ORGANIC  CHEMISTRY. 

JUST  PUBLISHED. 

A  Compend  of  Organic  Chemistry,  including  Medical 
Chemistry,  Urine  Analysis,  and  the  Analysis  of  Water, 
and  Yood,  etc.  By  HENRY  LEFFMANN,  M.D.,  Pro- 
fessor of  Clinical  Chemistry  and  Hygiene  in  the  Phila- 
delphia Polyclinic ;  Professor  of  Chemistry,  Penn- 
sylvania College  of  Dental  Surgery  ;  Member  of  the 
N.  Y.  Medico-Legal  Society.  Cloth.  $1.00. 

Interleaved,  for  the  addition  of  Notes,  $1.25. 

Nature  of  Organic  Bodies.  Transformations  under  various  con- 
ditions. Organic  Synthesis.  Homologous  and  Isomeric  Bodies. 
Empirical  and  Rational  formulae.  Classification  of  organic  bodies. 
Hydrocarbon.  Derivatives  of  Hydrocarbons.  Alcohols  and  Ethers. 
Benzenes  and  Turpenes.  Fat  Acids,  Oils  and  Fats,  Sugars,  Gluco- 
sides.  Cyanogen  Compounds  Amines  and  Amides.  Alkaloids. 
Ptomaines.  Animal  Chemistry.  Nutrition  and  Assimilation. 
Food,  Water  and  Air.  Urinary  Analysis.  Index. 


The  Essentials  of  Pathology. 

BY  D.  TOD  GILLIAM,  M.D., 
Professor  of  Physiology  in  Starling  Medical  College,  Columbus,  O . 

With  47  Illustrations.  12mo.  Cloth.  Price  $2.00. 
***  The  object  of  this  book  is  to  unfold  to  the  beginner  the  funda- 
mentals of  pathology  in  a  plain,  practical  way,  and  oy  bringing  them 
within  easy  comprehension  to  increase  his  interest  in  the  study  of 
the  subject.  Though  it  will  not  altogether  supplant  larger  works, 
it  will  be  found  to  impart  clear-cut  conceptions  of  the  generally 
accepted  doctrines  of  the  day,  and  to  prevent  confusion  in  the  mind 
of  the  student. 


A  POCKET-BOOK  « >F 

PHYSICAL    DIAGNOSIS 

OF    Till: 

Diseases  ofihe  Heart  and  Lungs. 

A   MANUAL  FOR  STUDENTS  AND   PHYSICIANS. 

BY  DR.  EDWARD  T.  BRUEN, 

Demonstrator  of  Clinical  Medicine  in  the  University  of  Pennsyl- 
vania, Assistant  Physician  to  the  University  Hospital,  etc. 

Second  Edition,  Revised.  With  new  Illustrations.  12mo.  $1.50. 
%*The  subject  is  treated  in  a  plain,  practical  manner,  avoiding 
questions  of  historical  or  theoretical  interest,  and  without  laying 
special  claim  to  originality  of  matter,  the  author  has  made  a  book 
that  presents  the  somewhat  difficult  points  of  Physical  Diagnosis 
clearly  and  distinctly. 


STUDENTS'  MANUALS. 


TYSON,  ON  THE  URINE.  A  Practical  Guide  to 
the  Examination  of  Urine.  For  Physicians  and  Stu- 
dents. By  JAMES  TYSON,  M.D.,  Professor  of  Path- 
ology and  Morbid  Anatomy,  University  of  Pennsylva- 
nia. With  Colored  Plates  and  Wood  Engravings. 
Fourth  Edition.  I2mo,  cloth,  $1.50 

HEATH'S  MINOR  SURGERY.  A  Manual  of 
Minor  Surgery  and  Bandaging.  By  CHRISTOPHER 
HEATH,  M.D.,  Surgeon  to  University  College  Hospital, 
London.  6th  Edition,  115  111.  I2mo,  cloth,  $2.00 

REESE.  A  MANUAL  OF  MEDICAL  JURIS- 
PRUDENCE and  Toxicology,  for  Students  and 
Physicians.  Small  8vo,  550  pages. 

VIRCHOW'S  POST-MORTEMS.  Post-Mortem 
Examinations.  A  Description  and  Explanation  of  the 
Methods  of  Performing  them.  By  PROF.  RUDOLPH 
VIRCHOW,  of  Berlin.  Translated  by  DR.  T.  B.  SMITH. 
2d  Ed.  4  Lithographic  Plates.  I2mo,  cloth,  $1.25 

DULLES'  ACCIDENTS  AND  EMERGEN- 
CIES. What  To  Do  First  in  Accidents  and  Emer- 
gencies. A  Manual  Explaining  the  Treatment  of 
Surgical  and  other  Accidents,  Poisoning,  etc..  By 
CHARLES  W.  DULLES,  M.D.,  Surgeon  Out-door  De- 
partment, Presbyterian  Hospital,  Philadelphia.  Col- 
ored Plate  and  other  Illustrations.  32mo,  cloth,  .75 

BEALE,  ON  SLIGHT  AILMENTS.  Their  Na- 
ture and  Treatment.  By  LIONEL  S.  BEALE,  M.D., 
F.R.S.  Second  Edition.  Revised,  Enlarged  and  Illus- 
trated. 283  pages.  8vo. 

Paper  covers,  75  cents;  cloth,  $1.25 

ALLINGHAM,  ON  THE  RECTUM.  Fistulae, 
Hemorrhoids,  Painful  Ulcer,  Stricture,  Prolapsus,  and 
other  Diseases  of  the  Rectum ;  Their  Diagnosis  and 
Treatment.  By  WM.  ALLINGHAM,  M.D.  Fourth  Re- 
vised and  Enlarged  Edition.  Illustrated.  8vo. 

Paper  covers,  75  cents;  cloth,  $1.25 

THOMPSON,  ON  THE  URINARY  ORGANS. 
On  Diseases  of  the  Urinary  Organs.  By  SIR  HENRY 
THOMPSON,  M.D.,  F.R.C.S.  Seventh  Edition.  84  Illus- 
trations, 8vo,  Paper  covers,  75  cents;  cloth,  $1.25 


STUDENTS'  MANUALS. 


MARSHALL  AND  SMITH,  ON  THE  URINE. 

The  Chemical  Analysis  of  the  Urine.  By  JOHN  MAR- 
SHALL, M.D.,  Chemical  Laboratory,  University  of  Penn- 
sylvania, and  PROF.  E.  F.  SMITH.  Illus.  Cloth,  $i  oo 

MEARS'  PRACTICAL  SURGERY.  Surgical 
Dressings,  Bandaging,  Ligation,  Amputation,  etc.  By 
J.  EWING  MEARS,  M.D.,  Demonstrator  of  Surgery  in 
Jefferson  Med.  College.  227  Illus.  2d  Ed.  In  Press. 

HOLDEN'S  ANATOMY.  A  Manual  of  the  Dis- 
section of  the  Human  Body.  Fifth  Edition,  Revised 
and  Enlarged,  with  over  170  Illustrations. 

BLOXAM'S  LABORATORY  TEACHINGS. 
Progressive  Exercises  in  Practical  Chemistry.  By  PROF. 
C.  L.  BLOXAM.  89  Illustrations.  I2mo,  cloth,  $1.75 

TYSON,  ON  THE  CELL  DOCTRINE;  its  His- 
tory and  Present  State.  By  PROF.  JAMES  TYSON,  M.D. 
Second  Edition.  Illustrated.  I2mo,  cloth,  $2.00 

MEADOWS'"  MIDWIFERY.  A  Manual  for  Stu- 
dents. By  ALFRED  MEADOWS,  M.D.  From  Fourth 
London  Edition.  145  Illustrations.  8vo,  cloth,  $2.00 

WYTHE'S  DOSE  AND  SYMPTOM  BOOK. 
Containing  the  Doses  and  Uses  of  all  the  principal 
Articles  of  the  Materia  Medica,  etc.  Eleventh  Edi- 
tion. 32mo,  cloth,  $1.00;  pocket  book  style,  $1.25 

PHYSICIAN'S  PRESCRIPTION  BOOK.  Con- 
taining Lists  of  Terms,  Phrases,  Contractions  and 
Abbreviations  used  in  Prescriptions,  Explanatory  Notes, 
Grammatical  Construction  of  Prescriptions,  etc.,  etc. 
By  PROF.  JONATHAN  PEREIRA,  M.D.  Sixteenth  Edi- 
tion. 32mo,  cloth,  #i.oo;  pocket-book  style,  $i. 25 

POCKET  LEXICONS. 

CLEAVELAND'S  POCKET  MEDICAL  LEXI- 
CON. A  Medical  Lexicon,  containing  correct  Pro- 
nunciation  and  Definition  of  Terms  used  in  Medi- 
cine and  the  Collateral  Sciences.  Thirtieth  Edition. 
Very  small  pocket  size.  Red  Edges. 

Cloth,  75  cents;  pocket-book  style,  jgi.oo 

LONGLEY'S  POCKET  DICTIONARY.  The 
Student's  Medical  Lexicon,  giving  Definition  and  Pro- 
nunciation of  all  Terms  used  in  Medicine,  with  an 
Appendix  giving  Poisons  and  Their  Antidotes,  Abbre- 
viations used  in  Prescriptions,  Metric  Scale  of  Doses, 
etc.  24mo,  cloth,  $1.00;  pocket-book  style,  £1.25 


ROBERTS'  PRACTICE. 

FIFTH  EDITION. 
Recommended  as  a    Text-book  at   University   of  Pennsylvania, 

Long  Island  College  Hospital,  Yale  and  Harvard  Colleges, 
Bishop' s  College,  Montreal,  University  of  Michigan,  and 

over  twenty  other  Medical  Schools. 
A  HANDBOOK  OF  THE  THEORY  AND   PRACTICE  OF 

MEDICINE.      By   FREDERICK   T.    ROBERTS,   M.D.,   M.R.C.P., 

Professor  of  Clinical  Medicine  and  Therapeutics  in  University 

College  Hospital,  London.     Fifth  Edition.     Octavo. 

CLOTH,  $5.00;  LEATHEB,  $6.00. 

*#*  This  new  edition  has  been  subjected  to  a  careful  revision. 
Many  chapters  have  been  rewritten.  Important  alterations  and 
additions  have  been  made  throughout,  and  new  illustrations  intro- 
duced. 

"A  clear,  yet  concise,  scientific  and  practical  work.  It  is  a  capi- 
tal compendium  of  the  classified  knowledge  of  the  subject." — Prof. 
J.  Adams  Allen,  Rush  Medical  College,  Chicago. 

"  I  have  become  thoroughly  convinced  of  its  great  value,  and 
have  cordially  recommended  it  to  my  class  in  Yale  College." — 
Prof.  David  P.  Smith. 

"  I  have  examined  it  with  some  care,  and  think  it  a  good  book, 
and  shall  take  pleasure  in  mentioning  it  among  the  works  which 
may  properly  be  put  in  the  hands  of  students." — A.  B.  Palmer, 
Prof,  of  the  Practice  of  Medicine,  University  of  Michigan. 

"  It  is  unsurpassed  by  any  work,  that  has  fallen  into  our  hands, 
as  a  compendium  for  students  preparing  for  examination.  It  is 
thoroughly  practical,  and  fully  up  to  the  times." — The  Clinic. 

"  Our  opinion  of  it  is  one  of  almost  unqualified  praise.  The 
style  is  clear,  and  the  amount  of  useful  and,  indeed,  indispensable 
information  which  it  contains  is  marvelous." — Boston  Medical  and 
Surgical  Journal. 

RIDDLE'S  MATERIA  MEDICA. 

NINTH  REVISED  EDITION. 

Recommended  as  a    Text-book  at    Yale    College,    University  of 
Michigan,   College  of  Physicians  and  Surgeons,  Baltimore, 
Baltimore  Medical  College,  Louisville  Medical  College, 
and  a  number  of  other  Colleges  throughout  the  U.  S.    ' 
BIDDLE'S  MATERIA  MEDICA.     For  the  Use  of  Students  and 
Physicians.     By  the  late  PROF.  JOHN  B.  BIDDLE,  M.D.,  Profes- 
sor of  Materia  Medica  in  Jefferson  Medical  College,  Philadelphia. 
The  Ninth  Edition,  thoroughly  revised,  and  in  many  parts  re- 
written, by  his   son,  CLEMENT   BIDDLE,  M.D.,    Past  Assistant 
Surgeon,  U.  S.  Navy,  assisted  by  HENRY  MORKIS,  M.D. 

CLOTH,  $4.00  ;  LEATHER,  $4.75. 
"  I  shall    unhesitatingly  recommend  it  (the  gth   Edition)  to  my 
students  at  the  BELLEVUE  HOSPITAL  MEDICAL  COLLEGE. — Prof. 
A.  A.  Smith,  New  York,  June,  1883. 

"  The  standard  '  Materia  Medica    with  a  large  number  of  medi- 
cal students  is  Biddle's." — Buffalo  Medical  and  Surgical  Journal. 
"The "larger  works  usually  recommended  as  text-books  in  our 
medical  schools  are  too  voluminous  for  convenient  use.     This  work 
will  be  found  to  contain  in  a  condensed  form  all  that  is  most  valuable, 
and  will  supply  students  with  a  reliable  guide." — Chicago  Med.  Jl. 
*#*  This  Ninth  Edition  contains  all  the  additions  and  changes  in 
the  U.  S.  Pharmacopoeia,  Sixth  Revision. 


STANDARD  TEXT-BOOKS. 

BLOXAM'S  CHEMISTRY.  Inorganic  and  Organic, 'with  Ex- 
periments. Fifth  Edition.  Revised  and  Illustrated. 

8vo,  cloth,  $3.75 ;  leather,  $4.75 

CARPENTER  ON  THE  MICROSCOPE  and  Its  Revelations. 
Sixth  Edition,  Enlarged.  With  500  Illustrations  and  Colored 
Plates,  handsomely  printed.  Demi  8vo,  cloth,  $5.50 

DRUITT'S  SURGERY.  A  Manual  of  Modern  Surgery.  Elev- 
enth London  Edition.  369  Illustrations.  Demi  8vo,  cloth,  $5.00 

FLOWER,  DIAGRAMS  OF  THE  NERVES  of  the  Human 
Body,  Origin,  Divisions,  Connections,  etc.  410.  .Cloth,  $3.50 

GALLABIN'S  MIDWIFERY.  A  Manual  for  Students.  Illus- 
trated.  In  Preparation. 

GLISAN'S  MODERN  MIDWIFERY.  A  Text-book.  129 
Illustrations.  8 vo,  cloth,  $ 4.00;  leather,  £5.00 

HOLDEN'S  ANATOMY  and  Manual  of  Dissections  of  the 
Human  Body.  Fourth  Edition.  Illus.  New  Ed.  In  Press. 

HOLDEN'S  OSTEOLOGY.  A  Description  of  the  Bones,  with 
Colored  Delineations  of  the  Attachments  of  the  Muscles.  Sixth 
Edition.  61  Lithographic  Plates  and  many  Wood  Engravings. 

Royal  8vo,  cloth,  $6.00 

HEATH'S  PRACTICAL  ANATOMY  and  Manual  of  Dissec- 
tions. Fifth  Edition.  24  Colored  Plates  and  nearly  300  other 
Illustrations.  Demi  8vo,  cloth,  $5.00 

HEADLAND,  THE  ACTION  OF  MEDICINE  in  the  System. 
Ninth  American  Edition.  8vo,  cloth,  $3.00 

KIRKE'S  PHYSIOLOGY.  A  Handbook  for  Students.  Tenth 
Edition.  420  Illustrations.  Demi  8vo,  cloth,  $5.00 

MANN'S  PSYCHOLOGICAL  MEDICINE  and  Allied  Ner- 
vous Diseases;  including  the  Medico-Legal  Aspects  of  Insanity. 
With  Illustrations.  8vo.  cloth,  $5.00  ;  leather,  *6.oo. 

MACNAMARA  ON  THE  EYE.  A  Manual  for  Students  and 
Physicians.  Illustrated.  Demi  8vo,  cloth,  $4.00 

MEIGS  AND  PEPPER  ON  CHILDREN.  A  Practical  Trea- 
tise on  Diseases  of  Children.  Seventh  Edition,  Revised. 

8vo,  cloth,  *6.oo  ;  leather,  $7.00 

PARKES'  PRACTICAL  HYGIENE.  Sixth  Revised  and  En- 
larged  Edition.  Illustrated.  8vo,  cloth,  $3.00 

RIGBY'S  OBSTETRIC  MEMORANDA.        32mo,  cloth,  .?o 

SANDERSONS  FOSTER'S  PHYSIOLOGICAL  LABOR- 
ATORY. A  Handbook  for  the  Laboratory.  Over  350  Illustra- 
tions. 8vo,  cloth,  $5.00  ;  leather,  *6.oo 

WILSON'S  HUMAN  ANATOMY.  General  and  Special. 
Tenth  Edition.  26  Colored  Plates  and  424  Illustrations.  $6.00 

WYTHE'S  MICROSCOPIST.  A  Manual  of  Microscopy  and 
Compend  of  the  Microscopic  Sciences.  Fourth  Edition.  252 
Illustrations.  8vo,  cloth,  $3.00;  leather,  $4.00 

AITKEN,  THE  SCIENCE  AND  PRACTICE  OF  MEDI- 
CINE. A  New  (Seventh)  Edition.  2  Vols. 

8vo,  cloth,  $12.00;  leather,  $14.00 

ACTON,  ON  THE  REPRODUCTIVE  ORGANS.  Their 
Functions,  1  borders  and  Treatment.  6th  Edition.  Cloth,  $2.00 

FENNER,ON  VISION.  Its  Optical  Defects  and  the  Adaptation 
of  Spectacles.  2d  Edition.  Enlarged.  Illus.  8vo.,  cloth,  $3.50 

FOTHERGILL,  ON  THE  HEART.  Its  Diseases  and  their 
Treatment  Second  Edition.  8vo,  cloth,  $3.50 

HARLEY  ON  THE  LIVER.  Diagnosis  and  Treatment.  Col- 
ored Plates  and  other  Illustrations.  8vo,  cloth,  $5.00;  sheep,  $9.00 


N  ENCYCLOPAEDIA  OF  MEDICAL  KNOWLEDGE. €=®jl 

INDEX  OF  DISEASES; 

WITH  TREATMENT  AND  FORMULAE. 

By  THOS.  HAWKES  TANNER,  M.D. 

REVISED  AND  ENLARGED  BY  DR.  BROADBENT. 

Octavo,  Cloth.    Price  $3.00. 

*#*  The  worth  of  a  work  of  this  kind,  by  so  eminent  a  professor 
as  Dr.  Tanner,  cannot  be  over-estimated.  As  an  aid  to  physicians 
and  druggists,  both  in  the  country  and  city,  it  must  be  invaluable. 
It  contains  a  full  list  of  all  diseases,  arranged  in  alphabetical  order, 
with  list  of  formulae,  and  appendix  giving  points  of  interest  regard- 
ing health  resorts,  mineral  waters,  and  information  about  cooking 
and  preparing  food,  etc.,  for  the  invalid  and  convalescent.  The 
page  headings  are  so  indexed  that  the  reader  is  enabled  to  find 
at  once  the  disease  wanted  ;  its  synonyms,  classification,  varie- 
ties, description,  etc.,  with  the  course  of  treatment  recommended 
by  the  best  authorities,  and  is  referred,  by  number,  to  the  several 
prescriptions  that  have  proved  most  efficacious.  These  prescrip- 
tions are  also  arranged  so  that  they  can  be  easily  referred  to,  with 
directions  how  to  use  them,  when  to  use  them,  and  what  diseases 
they  are  generally  used  in  treating.  The  directions  for  cooking 
foods  and  preparing  poultices,  lotions,  etc.,  are  very  full.  The 
work  will  be  found  specially  useful  to  students  and  young  physicians. 

RICHTER'S  CHEMISTRY, 

A  TEXT-BOOK  of  INORGANIC  CHEMISTRY  for  STUDENTS. 
By  PROF.  VICTOR  von  RICHTER, 

University  of  Breslau, 
AUTHORIZED  TRANSLATION  FROM  THE  THIRD  GERMAN  EDITION, 

By  EDGAR  F.  SMITH,  M.A.,  Ph.D., 
Professor  of  Chemistry  in  Wittenberg  College,  Springfield,  Ohio: 

formerly  in  the  Laboratories  of  the  University  of  Pennsyl- 
vania ;  Member  of  the  Chemical  Society  of  Berlin. 
12mo.  89  Wood-cuts  and  Col.  Lithographic  Plate  of  Spectra.  $2.00 

In  the  chemical  text-books  of  the  present  day,  one  of  the  striking 
features  and  difficulties  we  have  to  contend  with  is  the  separate 
presentation  of  the  theories  and  facts  of  the  science.  These  are 
usually  taught  apart,  as  if  entirely  independent  of  each  other,  and 
those  experienced  in  teaching  the  subject  know  only  too  well  the 
trouble  encountered  in  attempting  to  get  the  student  properly  in- 
terested in  the  science  and  in  bringing  him  to  a  clear  comprehension 
of  the  same.  In  this  work  of  PROF.  VON  RICHTER,  which  has  been 
received  abroad  with  such  hearty  welcome,  two  editions  having 
been  rapidly  disposed  of,  theory  and  fact  are  brought  close  together, 
and  their  intimate  relation  clearly  shown.  From  careful  observa- 
tion of  experiments  and  their  results,  the  student  is  led  to  a  correct 
understanding  of  the  interesting  principles  of  chemistry.  The  de- 
scriptions of  the  various  inorganic  substances  are  full,  and  embody 
the  results  of  the  latest  discoveries. 

In  preparation,  "ORGANIC  CHEMISTRY,"  By  the  same 
author.  Translated. 


BYFORD,  DISEASES  OF  WOMEN. 

NEW  REVISED  EDITION. 

The  Practice  of  Medicine  and  Surgery,  as  applied  to  the 
Diseases  of  Women.  By  W.  H.  BYFORD,  A.M.,  M.D., 
Professor  of  Gynaecology  in  Rush  Medical  College; 
of  Obstetrics  in  the  Woman's  Medical  College ;  Sur- 
geon to  the  Woman's  Hospital;  President  of  the 
American  Gynaecological  Society,  etc.  Third  Edition. 
Revised  and  Enlarged;  much  of  it  Rewritten;  with 
over  1 60  Illustrations.  Octavo. 

PRICE,  CLOTH,  $5.00;  LEATHER,  $6.00. 

"  The  treatise  is  as  complete  a  one  as  the  present  state  of  our 
science  will  admit  of  being  written.  We  commend  it  to  the  diligent 
study  of  every  practitioner  and  student,  as  a  work  calculated  to  in- 
culcate sound  principles  and  lead  to  enlightened  practice." — New 
York  Medical  Record. 

"  The  author  is  an  experienced  writer,  an  able  teacher  in  his  de- 
partment, and  has  embodied  in  the  present  work  the  results  of  a 
wide  field  of  practical  observation..  We  have  not  had  time  to  read 
its  pages  critically,  but  freely  commend  it  to  all  our  readers,  as  one 
of  the  niost  valuable  practical  works  issued  from  the  American 
press." — Chicago  Medical  Examiner. 

DAY  ON  CHILDREN.    Second  Edition. 

The  Diseases  of  Children.  A  Practical  and  Systematic 
Treatise  for  Practitioners  and  Students.  By  WILLIAM 
1 1 .  DAY,  M.D.,  Author  of  "  Headaches ;  Their  Causes, 
Nature  and  Treatment ;"  Member  of  the  Royal  College 
of  Physicians  of  London ;  Physician  to  the  Samaritan 
Hospital  for  Women  and  Children,  etc.  Second  Ed. 
Rewritten  and  very  much  Enlarged.  8vo.  752  pp. 

PRICE.  CLOTH,  $5.00:  SHEEP,  $6.00. 

"  A  careful  examination  of  this  book  leads  us  to  characteri/e  it 
.is  a  plain,  straightforward  treatise  on  the  subject  upon  which  it 
treats  .  .  .  giving  sound  practical  advice." — Philad'a  Med.  Times. 
"  (  >n  the  whole,  we  must  confess  we  are  pleased  with  this  book 
and  can  heartily  recommend  it — a  recommendation  which  it  does 
not  appear  to  need,  as  it  has  already  reached  its  second  edition." — 
American  Journal  of  Medical  Science. 

MACKENZIE,  THE  THROAT  AND  NOSE. 

l!y  MOKKI.I.   M.\(  KI.N/.II..  M.D.,  Senior  Physician  to  the 

Hospital  for  I  )i -cases  of  the  Chest  and  Throat ;  Lecturer 

on  Diseases  of  the  Throat  at  the  London  Hospital,  etc. 

VOL.  I.    Including  the  PHARYNX,  LARYNX,  TRACHEA, 

etc.     112  Illustrations.    ( 'loth,  54.00  ;  Leather,  $5.00 

VOL.    II.     DISEASES    «»r    im:    <KSOI>HA<;US,   NASAL 

CAVITIK*  AND  NKCK.    Cloth, $3.00;  Leather, $4,00 

The  two  volumes  at  one  time,    Cloth.  $6.00:  Leather,  $7.50 


YEO'S  PHYSIOLOGY. 

A  MANUAL  FOR  STUDENTS.     JUST  READY. 
300    CAREFULLY    PRINTED    ILLUSTRATIONS. 

FULL  GLOSSARY  AND  INDEX. 

By  GERALD  F.  YEO,  M.D.,  F.R.C.S.,  Professor  of  Physi- 
ology in  King's  College,  London.  Small  Octavo.  750 
pages.  Over  300  carefully  printed  Illustrations. 

PRICE,  CLOTH,  $4.00;  LEATHER,  $5.00. 

"  By  his  excellent  manual,  Prof.  Yeo  has  supplied  a  want  which 
must  have  been  felt  by  every  teacher  of  physiology.  *  *  *  * 
In  conclusion,  we  heartily  congratulate  Prof.  Yeo  on  his  work, 
which  we  can  recommend  to  all  those  who  wish  to  find  within  a 
moderate  compass  a  reliable  and  pleasantly  written  exposition  of 
all  the  essential  facts  of  physiology  as  the  science  now  stands." — 
The  Dublin  Journal  of  Med.  Science. 

"The  work  will  take  a  high  rank  among  the  smaller  text-books 
of  Physiology."— Prof.  H.  P.  Bowditch,  harvard  Med.  School, 
Boston. 

"  The  brief  examination  I  have  given  it  was  so  favorable  that  I 
placed  it  in  the  list  of  text-books  recommended  in  the  circular  of 
the  University  Medical  College." — Prof.  Lewis  A.  Stimpson, 
M.  D.,  37  East  33d  Street,  New  York. 

"  For  students'  use  it  is  one  of  the  very  best  text-books  in  Physi- 
ology."— Prof.  L.  B.  How,  Dartmouth  Med.  College,  Hanover, 
N.  fft 

RINDFLEISCH. 

THE  ELEMENTS  OF  PATHOLOGY. 

TRANSLATED  BY  WM.  H.  MERCUR,  M.D. 
REVISED  AND   EDITED   BY  PROF.  JAS.  TYSON, 

Of  the  University  of  Pennsylvania. 
OCTAVO.  CLOTH.  NEARLY  READY. 
*#.*  It  is  the  object  of  Prof.  Rindfleisch  to  present  in 
this  volume  of  moderate  size  the  fundamental  principles 
of  Pathology  A  large  number  of  the  general  processes 
which  underlie  disease,  a  knowledge  of  which  is  essen- 
tial to  the  practical  physician,  are  plainly  presented. 
They  include,  among  others,  inflammation,  tumor  forma- 
tion, fever,  derangements  of  nutrition,  including  atrophy, 
derangements  of  the  movement  of  the  blood,  of  blood 
formation  and  blood  purification,  hypenesthesia,  anaesthe- 
sia, convulsions,  paralysis,  etc.  The  well-known  reputa- 
tion of  the  author,  his  thorough  familiarity  with,  and  his 
method  of  treating  the  subject,  make  this  most  recent  work 
peculiarly  useful  to  the  student,  as  well  as  to  the  prac- 
ticing physician  who  wishes  to  brush  up  his  pathology. 


14  DAY  USE 

T°  DES*  **OM  WHICH  BORROWED 


W7 


• 


LD  21-40m-4  '64 
(E4555slO)476 


.  GeneraJ  Library 

University  of  CaJifornia 
Berkeley 


r  ,  aa  ...-  .    .  i     •.  • 
mm    '.'•  |  i  -       |p 

U.  C.  BERKELEY  LIBRARIES 


i    ft 


m      •  •    5 

P         -       •  I 

. 

' 

•      .. 


- 


, 


' 

^^^mgm 


^ 

BBBBBB 


